Dancers' perceptions of injuries
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Abstract:
Dance socioculture encourages dancers to perform through pain and injury and influences whether dancers will take time off in the event of an injury. The purpose of this study was to examine the impact dancers' mind-set and enculturation had on their decision to continue to train and perform through injury. Fifteen trained dancers (5 males and 10 females), age 27.7±14.25 years, completed a survey to determine the dancers' perceptions of injury and rehabilitation decisions post-injury. Findings indicate that enculturated perceptions may play a significant role in dancers' response to injury.
Key words: Dancers, injury, perceptions, enculturation, rehabilitation.Keywords:
Enculturation
The aim of this study was to ascertain current perceptions of strength training (ST) in dance from the viewpoint of the professional dancer, dance teacher, and student dancers across dance genres. A total of 168 responses (149 females, 19 males) to the modified Training Information Survey (TIS) were analyzed for differences in perceptions of ST between dance students, professional dancers, and dance teachers. Some significant differences were found between professionals and teachers (p > 0.05) and between students and teachers (p > 0.001). In all instances, dance teachers were less likely to agree with the following: ST is essential to my overall development as a dancer, women should participate in ST, men should participate in ST, ST should be part of every training program regardless of dance style, ST is beneficial to women, and ST increases bodyweight. It is evident that perceptions of ST still vary across the dance sector, and it is postulated that further education for dancers on the role ST has to play on the development of a dancer would help to break down barriers to participation. From this investigation, it can also be concluded that the perception that dancers have a fear of muscle hypertrophy and a negative impact on aesthetics is no longer widely prevalent, although it still permeates throughout the dance sector.
Dance education
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Affect
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Biopsychosocial model
Kinesiology
Back Pain
Ballet dancer
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OBJECTIVE: In high-performance sport, the use of self-report measures is expanding. The exploration of wellness states in response to training and performance requires further investigation for professional ballet dancers and athletes. This study therefore aimed to: compare wellness scores between professional ballet dancers and athletes in training and performance; report frequency of self-reported modified participation during training and performance; and report frequency of self-reported inability to participate due to pain and illness in dancers and athletes. METHODS: Fourteen professional ballet dancers (mean 26 yrs, SD 2.6) and 14 sex- and age-matched professional athletes (mean 27.7 yrs, SD 2.9) recorded daily wellness (fatigue, stress, sleep quality and quantity), participation (full, rest, modified, or unable to participate) and activity (performance, training) into a wellness application on their smart phone over a 4-month period. Mixed factorial ANOVAs were conducted to assess the interaction between group (ballet dancers and athletes) and activity (performance and training) on the dependent variables (stress, fatigue, sleep quality, and sleep quantity). RESULTS: Stress and fatigue levels were higher for both dancers and athletes during performance compared to training periods. Dancers recorded lower sleep quantity than athletes, with no difference in sleep quality. Modified participation appears more common in dancers compared to athletes. Dancers and athletes were rarely unable to train or perform/compete over the 4 months. CONCLUSION: Self-reported wellness scores appear sensitive to activity type and can provide valuable information to guide intervention and recovery strategies. Further research on the impact of poor wellness on performance, illness, and injury in professional ballet is warranted.
Ballet dancer
Repeated measures design
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The purpose of this study was to systematically review the literature and synthesise the evidence on injury rates and characteristics in recreational, elite student, and professional dancers. Five online databases were searched from inception to January 2018 and screened by two independent reviewers. Primary research studies were eligible for inclusion if they reported injury rates in recreational, elite student, and/or professional dancers of any genre and measured individual dance exposure at the hour, event, or day level. Sixteen studies were included, with only three studies incorporating recreational dancers. Reported injury incidence rates were less than 5 injuries per 1,000 dance hours, however substantially different definitions and methods for measuring injury and dance exposure were used. Based on the current evidence there is not an identifiable difference in injury rate or characteristics between recreational, elite student, and professional dancers. However, there remains a lack of high quality comprehensive data available across levels and genres of dance participation, and greater focus on consistency and completeness of reporting in dance injury research is still required.
Elite
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This systematic review examines the relationship between injury and two stages of a dancer's career development: when transitioning to full-time training and to a professional dance company. The findings are discussed in relation to managing transitioning loads with regard to injury prevention. Six electronic databases (PubMed, Embase, CINAHL, SPORTDiscus, Scopus, and Performing Arts Periodicals Database) were searched from inception to July 2018, inclusive of English language peer reviewed studies investigating injury in pre-professional and professional ballet and contemporary dancers. Seventeen studies met the inclusion criteria. "Limited" evidence revealed that dancers transitioning to professional ballet had a significantly higher rate of time-loss injuries per exposure hour relative to established professionals, whereas transitioning professional contemporary dancers had a significantly lower rate of both medical-attention and time-loss injuries. "Limited" evidence also showed a decreased rate and trend toward lower prevalence rates for time-loss injuries per exposure hour for transitioning ballet students and an increased rate of medical-attention injury in a combined cohort of transitioning ballet and contemporary dance students. Thus, this review provides some evidence that injuries tend to occur as dancers are transitioning to full-time ballet or contemporary dance training or to professional careers.
Classical ballet
CINAHL
Dance education
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PURPOSE: Low back pain (LBP) is often cited as one of the most common musculoskeletal conditions experienced by pre-professional and professionals dancers, although there is a dearth of evidence to support this. The purpose of this study was: i) to determine the prevalence of LBP in dancers, as well as the impact on practice and management strategies used by dancers; and ii) to identify any demographic or physical factors associated with LBP in dancers. METHODS: This was a prospective cohort study of 110 (n=19 male) pre-professional and professional classical ballet and contemporary dancers (mean (SD) age 17.8 (2.9) years). Data were collected using an online questionnaire repeated monthly for 9 months. Univariate and multivariate analyses were conducted to determine demographic and physical factors related to LBP prevalence. RESULTS: 74% of dancers reported a history of LBP. Preliminary analysis revealed a monthly and point prevalence between 40 to 60% and 16 to 25% respectively. Each month, between 35 to 63% of all episodes of LBP resulted in some form of activity modification or time away from dance, 16 to 27% of dancers with back pain consulted a health professional and 15 to 30% used medication for their back pain. Multivariate analysis found no association with individual or demographic factors and history of LBP. CONCLUSIONS: Pre-professional and professional dancers have an increased vulnerability to LBP. The development of LBP within this population is complex and may not be associated with individual factors measured in this study.
Back Pain
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Dancers are often referred to as "athletes of the arts," and like other athletes they undergo years of hard physical training in pursuit of excellence. Previous research has indicated that dancers develop high pain thresholds and push past their pain barriers. This has potential implications for their health and wellbeing in both their professional careers and life after dance. Therefore, the purpose of this pilot study was to explore the perceptions and experiences of injury, pain, and retirement among professional dancers. Twenty professional dancers, 10 from the United Kingdom and Canada, hereafter referred to as "international," and 10 from Australia participated in a semi-structured interview reflecting on their experiences of the aforementioned issues. The following themes were identified: 1. the injured dancer: the reality; 2. dancers' perceptions and experiences of pain; 3. the transition leading to retirement; and 4. life after dance: attributes facilitating career change. Results from both Australian and international dancers revealed that they withstand, manage, and dance through persistent levels of pain and injury. All participants reported that they were highly motivated and dedicated to their dance careers; however, the majority of Australian dancers were not adequately prepared for, or aware of, the challenges of transition into their post-professional dance lives when compared to the international dancers. Dancer transition organizations currently operate in America, the Netherlands, Canada, and the United Kingdom and serve as valuable models that could be replicated in Australia. The current study recommends increased awareness of pain management and injury prevention strategies for dancers and further supports the rationale for development and implementation of transition models for dancers in Australia and elsewhere.
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Introduction
Dancers invest a great deal of time and effort into their training in order to attain elite levels of performance. However, quantity of practice alone is not enough to achieve elite performance, the quality of practice also plays an important role[1]. Professional dancers, and vocational dance students training to become professionals, undertake large training loads with practice time increasing prior to performances and assessments[2, 3]. Dancers must balance the stress of intense training loads along with non-training related stress (e.g., academic workloads, managing financial concerns, living away from family and friends) in order to achieve performance gains. If the appropriate balance between training and non-training stress and recovery is not met, the resulting maladaptation to training manifests in symptoms of underrecovery, overtraining, and burnout.
Overtraining and recovery has garnered attention in sports science research, however little is known about how dancers balance training and non-training stress with recovery in order to prevent negative training outcomes. Dancers are susceptible to overtraining[4] and one of the most commonly perceived reasons for injury, as reported by dancers, is fatigue due to overload[5]. Fatigue, stress, injury, and psychosocial antecedents to burnout[6-8], and workload and rest (from a physiological perspective)[9], have been examined in dance specific populations. However, no research has examined recovery in dance specifically, and how enhancing recovery may improve dancers’ management of fatigue and stress needs investigation.
This study examined professional dancers’ experiences of stress and recovery during their vocational dance training as a basis for identifying potential risk factors for overtraining in dance. The Overtraining Risks and Outcomes Model (OROM)[10], conceptualises four stages of stress, recovery and overtraining in athletic populations. Stage one outlines risk factors that increase stress experienced by athletes. Stage two concerns stress-recovery imbalance and early signs of overtraining. The third stage concerns individuals’ behavioural responses to overtraining, where adaptive responses lead to a return to a state of balance, and an improvement in performance, and maladaptive behavioural responses lead to the negative outcomes addressed in stage 4, such as psychological or physical illness or injury, and ongoing fatigue. The aim of this research was to use the OROM[10] to develop an understanding of dancers’ experiences of overtraining and recovery, and how the stress-recovery balance is managed in professional and vocational dance contexts.
Methods
Participants & Procedure: Following university ethics approval, interviews were conducted with professional ballet (n = 4) and contemporary (n = 8) dancers (9 female, 3 male) who had previously undertaken vocational dance training. Participants ranged in age from 23 to 46 years (M = 34.06, SD 7.34) with professional dance experience ranging from 1 to 25 years (M = 9.96, SD = 7.69). The majority of the participants trained in Australia and three participants trained at international institutions. The participants included Freelance, Independent, Young, and Principal Artists, with five of the participants currently teaching contemporary and/or ballet.
The interviews were held at a time and location of convenience, lasting between 51:17 minutes and 1:36:45 hours. Interviews were conducted in three groups of three to four participants or individually (n = 3) to accommodate participant availability. All participants provided informed consent prior to data collection. Semi-structured interview questions were developed from the OROM[10], and interviews were transcribed verbatim by the first author.
Analysis: Thematic analysis was conducted utilising a template analysis approach to assess how participants’ experiences fit within the OROM[10]. Following transcription, initial codes were generated and collated into themes which were then reviewed to assist in defining and refining the specifics of each theme[11]. The second author independently coded a random selection of the interviews to enhance reliability and trustworthiness. Differences in the coding and themes generated were discussed and debated until agreement was reached. Results
Analyses revealed dancers’ experiences of stress and recovery during vocational training could be described within the OROM[10] (see Table 1). Three key themes were identified as central risk factors in vocational dance training: Identity (“There’s quite a lot of bravado…’good dancers work through things’, and I think we expect that of each other” [C7]), Pushing Through (“I’d push through and [my injuries would] get worse” [B4]), and Health (“When I got injured…they wanted me back as quick as possible…and that was a big problem” [B1]). Dancers’ behavioural responses to stress were identified as either Adaptive (“When you get injured…you have to learn to treat your body right” [B1]), or Maladaptive (“I remember taking laxatives, I started smoking”[B3]) (see Table 2). Discussion
Dancers face a unique set of specific risk factors for overtraining which may compromise recovery in light of the demands of vocational dance training. Health and Identity emerging as a key risk factors, particularly in relation to injury and body issues, corresponds with previous research suggesting that dancers experience stress related to physical factors such as physical appearance, physical fatigue and injury[12]. Whilst the demand for a specific body type and risk of injury may always be present in professional dance, understanding individual differences in responses to these risk factors may assist dancers to find adaptive ways of coping with increased stress related to these issues.
The theme of Pushing Through is unique to this study and warrants further investigation as to how the sociocultural norm of ‘pushing through’ in dance puts dancers at risk of overtraining. Several dancers in this study self-identified as people who “push through” and these dancers also reported experiencing outcomes indicative of overtraining (e.g., serious injury, debilitating psychological illness, prolonged fatigue and extended time off from dance). Examination of how and why dancers push beyond their capabilities will add to the current knowledge regarding links between fatigue and injury in dance[5].
Whilst some participants reported less healthy ways of dealing with stress (e.g., smoking, drinking, ignoring stressors) it was encouraging to note that several dancers reported adaptive behaviours when dealing with stress, such as taking time off, remedial massage for aches and pains, and drawing on social support from friends and family. Helping dancers identify adaptive strategies for coping with stress and minimising maladaptive behavioural responses will enable dancers to regulate their individual stress-recovery balance[12].
Conclusion
This study is a first step in understanding how risk factors for overtraining and behavioural responses related to recovery in vocational dance training may impact dancers’ health and performance. The findings suggest that assisting dancers identify how stress impacts their response to training, and improving recovery behaviours, is essential for intervention programs aimed at enhancing recovery and reducing the risk of overtraining in vocational dance training.
1. Kellmann, M., Enhancing recovery: Preventing underperformance in athletes. 2002: Human Kinetics.
2. Wyon, M., Preparing to Perform: Periodization and Dance. Journal of Dance Medicine & Science, 2010. 14(2): p. 67-72.
3. Grove, J.R., L.C. Main, and L. Sharp, Stressors, recovery processes, and manifestations of training distress in dance. Journal of Dance Medicine & Science, 2013. 17(2): p. 70-78.
4. Koutedakis, Y., Burnout in dance. Journal of Dance Medicine & Science, 2000. 4(4): p. 123.
5. Liederbach, M., L. Schanfein, and I.J. Kremenic, What is known about the effect of fatigue on injury occurrence among dancers? Journal of Dance Medicine & Science, 2013. 17(3): p. 101-108.
6. Liederbach, M. and J.M. Compagno, Psychological aspects of fatigue-related injuries in dancers. Journal of Dance Medicine & Science, 2001. 5(4): p. 116-120.
7. Noh, Y.E., T. Morris, and M.B. Andersen, Psychosocial stress and injury in dance. Journal of Physical Education, Recreation & Dance, 2003. 74(4): p. 36-40.
8. Quested, E. and J.L. Duda, Antecedents of burnout among elite dancers: A longitudinal test of basic needs theory. Psychology of sport and exercise, 2011. 12(2): p. 159-167.
9. Twitchett, E., et al., The demands of a working day among female professional ballet dancers. Journal of Dance Medicine & Science, 2010. 14(4): p. 127-132.
10. Richardson, S.O., M.B. Andersen, and T. Morris, Overtraining athletes: Personal journeys in sport. 2008: Human Kinetics.
11. Braun, V. and V. Clarke, Using thematic analysis in psychology. Qualitative Research in Psychology, 2006. 3(2): p. 77-101.
12. Noh, Y.-E., T. Morris, and M.B. Andersen, Occupational stress and coping strategies of professional ballet dancers in Korea. Medical Problems of Performing Artists, 2009. 24(3): p. 124.
Overtraining
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