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Injury as a stressor in 67 first year contemporary dance students: a longitudinal cohort study https://pmc.ncbi.nlm.nih.gov/articles/PMC12727637/
Kaufmann, J. E., Stubbe, J. H., van Rijn, R. M., Nelissen, R. G. H. H., & Gademan, M. G. J. (2025). Injury as a stressor in 67 first year contemporary dance students: a longitudinal cohort study. Frontiers in psychology, 16, 1504292. https://doi.org/10.3389/fpsyg.2025.1504292
Introduction
In athletes, injuries lead to increased stress but athletes cope better with subsequent than with first-time-injury. In dancers such information is lacking. Thus, we investigated whether injuries are associated with increased stress-levels, and if subsequent injuries are associated with higher perceived stress levels than first injury.
Methods
Bachelor dance students were prospectively followed during five academic years (2016-2022). During the first month of the year, respectively, baseline characteristics were recorded using the “Performing artist and Athlete Health Monitor” (PAHM) including the VAS pain scale, the VAS stress scale, and the “Oslo Sport Trauma Research Centre Questionnaire on Health Problems” (OSTRC). Throughout the year, stress, injuries and injury severity were reported monthly. The first-month assessment served as baseline in which dancers had to be injury free to be included in this analysis. Paired t-tests were conducted.
Results
67 dancers (age 18.8 ±.8 years, 58.2% female) sustained at least one injury, of those 33 at least one subsequent injury. OSTRC severity scores ranged from a mean of 28.7 ±17.5 for first injuries to 31.4 ±17.1 for subsequent injuries. The mean baseline stress level for injuries was 24.3 ±17.2. Stress levels during first and subsequent injuries were elevated compared to the baseline stress levels, 34.8 ± 18.7 and 35.1 ±23.0, respectively. There were no differences between stress levels during first and subsequent injuries.
Discussion
Injuries are associated with increased stress levels in dancers, but stress levels were equally high after first and subsequent injury. We emphasize the importance of a holistic approach to injury rehabilitation, thus not only focusing on the physiological injury as such, but also include the dancers’ psychological recovery and a focus on stress management for both enhanced recovery as well as prevention of future injuries.
Perspectives of Ballet Dancers on Causes of Their Injuries and Implementation of Injury Preventive Measures by Ballet Teachers and Masters
https://pubmed.ncbi.nlm.nih.gov/38814128/
Kaufmann, J. E., Stubbe, J. H., Nelissen, R. G., & Gademan, M. G. (2024). Perspectives of Ballet Dancers on Causes of Their Injuries and Implementation of Injury Preventive Measures by Ballet Teachers and Masters. Medical problems of performing artists, 39(2), 93–107. https://doi.org/10.21091/mppa.2024.2007
Objectives: Ballet dancers have a high injury risk. We aimed to gain insight into the causes for acute and overuse injuries in ballet dancers and the level of implementation of injury prevention by ballet teachers/masters, as perceived by dancers.
Methods: An international cross-sectional online-survey was based on the Fit-to-Dance Questionnaire and literature. Adult amateur, pre-professional, and professional ballet dancers reported the perceived causes of their injuries sustained in the previous 2 years. Multiple answers per injury were possible. Also, dancers rated the level of implementation of measures to prevent injury by their ballet teachers and ballet masters based on 21 items using a 5-point Likert scale. Causes were analyzed per-injury as well as per-dancer.
Results: 188 ballet ensembles and 51 dance organizations were contacted, from which 192 ballet dancers (mean age 27 ±7.8 yrs, 83% females) responded. 119 dancers (62%) reported 203 acute and 164 (85%) reported 469 overuse injuries. Fatigue was the most frequently perceived cause for acute injuries in the per-injury (n=89, 43.8%) and per-dancer analysis (n=63, 32.8%). For overuse injuries, pressure from the teacher/master was most frequently perceived as cause in the per-injury analysis (n=240, 51.2%), specifically in pre-/professional dancers (n=233, 61.3%). In the per-dancer analysis, fatigue/overtraining scored highest for overuse injuries (n=107; 55.7%). Other causes were previous/repetitive injuries (acute-per-injury 26.1%, acute-per-dancer 22.4%; overuse-per-injury 46.3%, overuse-per-dancer 53.1%) or erroneous dance technique (acute-per-injury 24.6%, acute-per-dancer 21.9%; overuse-per-injury 47.8%, overuse-per-dancer 45.3%). With regard to perceived level of implementation of injury preventive measures by ballet teachers/masters to prevent musculoskeletal injuries, 2 items received high ratings, 12 moderate ratings and 6 low ratings.
Conclusions: Fatigue and pressure accounted for the majority of perceived causes for injuries. Perceived support by ballet teachers/masters regarding injury prevention was moderate to low. Future research should focus on the awareness, attitudes, and the important role of ballet teachers/masters for injury prevention in dancers.
Neuromuscular Warm-Up is Associated with Fewer Overuse Injuries in Ballet Dancers Compared to Traditional Ballet-Specific Warm-Up
Kaufmann, J. E., Nelissen, R. G. H. H., Stubbe, J. H., & Gademan, M. G. J. (2022). Neuromuscular Warm-Up is Associated with Fewer Overuse Injuries in Ballet Dancers Compared to Traditional Ballet-Specific Warm-Up. Journal of dance medicine & science : official publication of the International Association for Dance Medicine & Science, 26(4), 244–254. https://doi.org/10.12678/1089-313X.121522e
Neuromuscular warm-up exercises (NMWU) have been shown to prevent injuries. In dance, research on warming-up is scarce. We investigated warm-up habits among ballet dancers and the effects of NMWU and traditional ballet-specific warm-up (TBSWU) on injuries. Using a cross-sectional survey among ballet dancers over the age of 18 years, we recorded acute and overuse injuries sustained in the previous 2 years. Warm-up behavior was assessed through 28 items. Dancers were grouped into NMWU or TBSWU: NMWU was based on neuromuscular warm-up programs in sports science and included exercises improving strength, power, proprioception, sensorimotor control, or cardiovascular stimulus; and TBSWU consisted of stretching, dance-technical exercises, marking steps and running-through-choreographies, or stretching with tools. Separate linear regression analyses adjusted for confounding factors were performed for acute and overuse injuries. A total of 192 dancers (26.7 ± 7.82 years, 159 females, 132 professionals) reported 203 acute and 469 overuse injuries. In total, 47.4% of dancers always warmed up (mean duration 20.7 ± 13.2 minutes) based on stretching (63%), technical-exercises (58.9%), strength-training (54.7%), and the barre (53.6%); and 9.4% never warmed up. A total of 31 dancers (16.15%) were classified as TBSWU, 16 dancers (8.3%) for NMWU, and 145 dancers did combined exercises. Those in the NMWU group were associated with fewer overuse injuries compared to those in the TBSWU group (β = -2.34; 95%CI -3.54 to -1.14). No association was found with acute injuries. As in other athletes, NMWU might be protective against overuse injuries in dancers. Large-scale prospective cohort studies are needed to gain more insight into NMWU as a possible component of injury prevention in ballet.
Perceptions of Motivational Climate and Association with Musculoskeletal Injuries in Ballet Dancers https://pubmed.ncbi.nlm.nih.gov/34464964/
Kaufmann, J. E., Nelissen, R. G., Appleton, P. R., & Gademan, M. G. (2021). Perceptions of Motivational Climate and Association with Musculoskeletal Injuries in Ballet Dancers. Medical problems of performing artists, 36(3), 187–198. https://doi.org/10.21091/mppa.2021.3021
Objective: Sports science has identified the trainer-athlete relationship in the etiology of injuries. We aimed to investigate: 1) the association between empowering (EMC) and disempowering (DMC) motivational-climate and musculoskeletal injuries in ballet, and 2) if EMC moderates the association between DMC and injuries.
Methods: A cross-sectional cohort survey-study was conducted online among ballet dancers (>18 yrs old) reporting acute and overuse injuries of the previous 2 years. Motivational climate was assessed with the Empowering-and-Disempowering Motivational Climate Questionnaire (5-point Likert scale). The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire assessed severity of overuse injuries. Linear regression was performed adjusted for the confounders age, sex, expertise, experience, and initiation-age with an interaction term between EMC and DMC to assess effect modification.
Results: An international sample of 189 dancers (26.7±7.9 yrs; 130 professionals) reported 197 acute and 465 overuse injuries (in the previous 2 years). Mean EMC was 3.1±1.07, DMC 3.3±1.08. EMC was associated with less acute (b=-0.22; 95%CI -0.40 to -0.04) and overuse injuries (b=-0.74; 95%CI -0.99 to -0.50), while DMC was associated with more injuries (acute: b=0.30; 95%CI 0.13 to 0.47; overuse: b=0.74; 95%CI 0.50 to 0.98). When tested together and adjusted for confounders, EMC lost its protective effect (acute: b=-0.15; 95%CI -0.19 to 0.49; overuse: b=-0.34; 95%CI -0.81 to 0.13). DMC was positively associated with injuries throughout all settings (acute: b=0.43; 95%CI 0.10 to 0.76; overuse: b=0.46; 95%CI 0.00 to 0.91). EMC showed no moderating effects on DMC in the adjusted models.
Conclusion: To avoid injuries, it is not enough to create an EMC, because any disempowering nuances may negatively affect empowering climates. Teachers should avoid DMC altogether to prevent injuries in dancers.
Does forced or compensated turnout lead to musculoskeletal injuries? A systematic review https://pubmed.ncbi.nlm.nih.gov/33338756/
Kaufmann, J. E., Nelissen, R. G. H. H., Exner-Grave, E., & Gademan, M. G. J. (2021). Does forced or compensated turnout lead to musculoskeletal injuries in dancers? A systematic review on the complexity of causes. Journal of biomechanics, 114, 110084. https://doi.org/10.1016/j.jbiomech.2020.110084
Injury prevalence in dancers is high, and misaligned turnout (TO) is claimed to bear injury risk. This systematic review aimed to investigate if compensating or forcing TO leads to musculoskeletal injuries. A systematic literature review was conducted according to the PRISMA Guidelines using the databases of PubMed, Embase, Emcare, Web of Science, Cochrane Library, Academic Search Premier, and ScienceDirect. Studies investigating the relationship between compensated or forced TO and injuries in all genders, all ages, and levels of dancers were included. Details on misaligned TO measurements and injuries had to be provided. Screening was performed by two researchers, data extraction and methodological quality assessment executed by one researcher and checked by another. 7 studies with 1293 dancers were included. Methodological quality was low due to study designs and a general lack of standardised definition of pathology and methods of assessment of misaligned TO. The studies investigating the lower extremities showed a hip-focus only. Non-hip contributors as well as their natural anatomical variations were not accounted for, limiting the understanding of injury mechanisms underlying misaligned TO. As such no definite conclusions on the effect of compensating or forcing TO on musculoskeletal injuries could be made. Total TO is dependent on complex motion cycles rather than generalised (hip) joint dominance only. Objective dual assessment of maximum passive joint range of motion through 3D kinematic analysis in combination with physical examination is needed to account for anatomical variations, locate sites prone to (overuse)injury, and investigate underlying injury mechanisms.
Keywords: Biomechanics; Dance; Injury prevention; Musculoskeletal injuries; Turnout.
Copyright © 2020 Elsevier Ltd. All rights reserved.
Deutsche Ausgabe (2016) und englische, stark erweiterte Buchserie (2021) zu Tanz, Tanzpädagogik & Tanzmedizin von Judith-Elisa Kaufmann, erhältlich bei Amazon bzw. im Buchhandel:
Die englische, stark erweitere Edition in vier Bänden erschien von Frühling bis Winter 2021 bei Amazon & im Buchhandel.
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