Dance 1003h Honors Basic Course in the Arts Movement and Dance 3 Hours

• Journal Listing
• Int J Sports Phys Ther
• v.12(iii); 2017 Jun
• PMC5455185

Int J Sports Phys Ther. 2017 Jun; 12(3): 352–370.

INJURY INCIDENCE, DANCE EXPOSURE AND THE Employ OF THE MOVEMENT COMPETENCY SCREEN (MCS) TO IDENTIFY VARIABLES ASSOCIATED WITH INJURY IN Full-TIME PRE-Professional DANCERS

Linda Lee, BPhty, MHSci (hons), PGDip Sp & Ex Medicine, PGCert Physio (Msk), ¹ Duncan Reid, DHSc, FNZCP, MHsc, PGDip (Manip Physio), Dip PT, BSc,² Jill Cadwell, MHSci(Hons), PGDHSci(Manip Ther.), PGDSportsMed, BPhty, DipPhys,² and Priya Palmer, BSc, MSc, PhD^two

Linda Lee

¹Sandringham, Auckland, New Zealand

Duncan Reid

²Auckland University of Technology, Auckland, New Zealand

Jill Cadwell

ⁱⁱAuckland University of Technology, Auckland, New Zealand

Priya Palmer

²Auckland University of Technology, Auckland, New Zealand

Abstract

Groundwork/Purposes

Prospective studies utilizing standardized injury and exposure measures are needed to consolidate our cognition of injury incidence and associated risk factors for musculoskeletal injury amongst pre-professional dancers. The purpose of this study was to investigate the injury incidence amidst pre-professional dancers attention a fulltime training school in New Zealand. The secondary purposes of this study were to investigate the human relationship betwixt dance exposure and injury risk, and the relationship between run a risk factors (specifically the MCS upshot scores) and injury run a risk.

Methods

A prospective cohort written report of 66 full-time pre-professional dancers was undertaken over one full academic twelvemonth (38 weeks), included 40 females (mean historic period 17.78 yrs, SD one.xviii) and 26 males (mean age 18.57yrs, SD one.72). Injury surveillance included both reported and self reported injury data. Dancers were screened using the MCS in the beginning week of term one.

Results

Eighty-half dozen per cent of dancers sustained one or more than injuries. Fifty-nine per cent of all injuries were fourth dimension-loss. The injury incidence rate was 2.27 per yard hours of dance exposure (DEhr) and 3.35 per k dance exposures (DE). At that place was a meaning association between the full number of injuries and total DE per month (B=0.003, 95% CI 0.001 - 0.006, p=0.016). Dancers who had a MCS score < 23 were more than likely to be injured than those who scored ≥23 (B = -0.702, 95% CI = -ane.354 – -0.050, p=0.035).

Conclusion

Injury prevalence and incidence was comparable with other international cohorts. The number of trip the light fantastic exposures was more highly associated with injury risk than the hours of dance exposure. The MCS may be a useful tool to help identify dancers at risk of injury.

Level of Testify

Level 3b, Prospective Longitudinal Cohort Study

Keywords: Dance, exposure, functional movement screening, injury, pre-professional

INTRODUCTION

Pre-professional dance training is enervating, and requires meaning physical and creative ability.^1,2 Long training hours coupled with highly repetitive movement patterns during a time of maturation and evolution places the pre-professional person dancer in a vulnerable position with regard to injury risk.^3,4 Several authors have highlighted musculoskeletal injuries as a significant ongoing health result for pre-professional person dancers.^1-3,v-xx However, consistent reporting of injury incidence is still necessary to enable the development and monitoring of injury prevention strategies.^ane,21-23

Chance factors for dance related injury are all the same non well understood.^{1,5,half dozen,24} The negative effects of changes in training load and/or preparation loads beyond an athlete's capacity have been cited equally potential gamble factors for injury.^25-31 To date there is a paucity of prospective studies examining the relationship between trip the light fantastic exposure and injury take a chance amidst pre-professional dancers. ^{1,12,xvi,32,33}

Pre-participation or pre-flavour screening inside trip the light fantastic schools and professional companies has go more than widely adopted as the need to optimize dancers' wellness is recognized as a critical factor in both developing and maintaining talent. ^34-42 Functional motility screening tools designed to identify deficits in neuromuscular control, have gained popularity within the sporting arena equally an effective and efficient screening strategy. ^43-fifty The utility of functional move screening tools, and more specifically the MCS, to find dancers at chance of injury requires farther investigation. ^45,47,51,52 The purpose of this written report was to investigate the injury incidence among pre-professional person dancers attending a fulltime training school in New Zealand. The secondary purposes of this study were to investigate the relationship betwixt dance exposure and injury risk, and the relationship between take chances factors (specifically the MCS outcome scores) and injury risk.

METHODS

Written report blueprint

A prospective cohort study was conducted over one full bookish year (38 weeks). Approving for was gained from the Auckland University of Engineering science (AUT) Ethics Commission. All participants received both exact and written study information and gave written informed consent.

Participants

Students attending an elite full-time pre-professional person dance school in New Zealand were invited to participate (northward=86). A total of 66 dancers completed the necessary documentation and movement screening session at the beginning of the study.

Injury Surveillance

Participating dancers completed an initial questionnaire that collected information on potential risk factors including: age, height, weight, BMI, gender, previous and current injury history, year of pre-professional person trip the light fantastic toe training, trip the light fantastic major, and age started dancing. Prospective injury surveillance was undertaken over one total academic year. The dance school physiotherapist completed a standardized Injury Summary Sheet (Appendix 1) and International Performing Arts Injury Reporting Survey (IPAIRS©) for all reported injuries. Self-reported injury data was collected via an online survey tool (http://surveymonkey.com) and sent to participating students every three weeks. Injury was defined as, "any physical complaint sustained by a dancer resulting from functioning, rehearsal or class, and resulting in a dancer injury report or triage, irrespective of the need for medical attention or fourth dimension-loss from dance activities".⁵³ Injury was so also sub-classified based on current recommendations; including time-loss or not time-loss, nature of injury i.e. acute or overuse, and if an injury was new or recurrent.^54-56 Recurrent injuries were further classified as exacerbations or re-injuries.⁵⁵ (Appendix two) Injury severity was coded, S0 (no days off or modified), S1 (activity modification), S2 ( ≤ 7 days off), S3 ( > seven days off) or S4 (year ending).^iii,57

Dance Exposure

Dance exposure (DE) was defined as, "1 dancer participating in ane class, rehearsal or performance in which he or she is exposed to the possibility of dance injury regardless of the time associated with that participation".⁵⁸ Total dance exposure (hours and events), was calculated from the weekly timetables for each year of study (major and gender).

MCS screening and scoring

All participants were screened using the Motion Competency Screen (MCS^©) in the first week of term one. The MCS is comprised of five fundamental movement patterns (body weight squat, lunge twist, single leg squat, curve and pull, push upward) and iii dynamic leap patterns (counter motion jump, counter movement leap with unilateral country, broad bound with unilateral land) (Appendix three, Appendix 4).^47,59 The subjects were filmed using Casio EX-ZR100 digital cameras (Shibuya-ku, Tokyo). Video analysis of each movement blueprint was performed past the primary researcher, and scored using standardized criteria directly adapted from the original MCS 100 criteria described past Kritz,⁴⁵ and that were used past Vanweerd⁴⁷ for the Netball Movement Competency Screen.^45,47,59 (Appendix 5) Whole body movement is assessed for each move blueprint and scored from 0 – 3, based on identification of primary or secondary areas of concern as described past Kritz.⁴⁵ Primary areas of concern are those that are most probable to impact on the athlete's movement competency during the selected movement job.⁴⁵ A score of ane indicates poor movement competency, while a score of iii indicates proficient movement competency. All unilateral movements were assessed and scored bilaterally. The scores of all individual movements were totalled to provide a composite outcome score (out of a possible 36). The reliability of the MCS has been shown to be proficient to excellent in boyish female netballers⁵² and in war machine populations.⁶⁰ Prior to the current study a pilot written report assessed the intra-rater reliability of the primary researcher using the MCS. Intra-rater reliability was established using boilerplate measures intra-grade correlation coefficient (ICC). The ICC _(2,1) for the overall MCS scores in ten subjects was first-class (ICC _(ii,1) 0.99, CI 0.98 - 0.99).

Statistical Analysis

Descriptive analysis of the data established the injury prevalence and incidence of reported injuries. Injury prevalence was divers every bit the total number of reported injuries in one full academic yr. Injury incidence over the academic year (Jan-Dec) was expressed as the number of reported injuries per 1000 hours of trip the light fantastic exposure (DEhr). Injury rates were likewise calculated using the number of reported injuries per 1000 dance exposures (DE), as it is considered to achieve a college level of reliability as well equally comparability betweeen cohorts, and is also consistent with reporting methods utilized by other international sporting bodies.^58,61 Pearson's correlations were used to determine the relationship betwixt dance exposure and injury. A univariate linear regression model was used to investigate the human relationship between injury condition and private potential take a chance factors. A multivariate linear regression model was used to examine the influence of a combination of risk factors for condign injured. Covariates were fitted into the model using a frontwards option procedure and were retained in the final linear regression model if they reached a statistical threshold of p<0.10 or were of clinical significance. A logistic regression was used to investigate the relationship between injury severity and possible risk factors. All analyses were performed using Statistical Plan for Social Science (SPSS) software (SPSS V.22, IBM Corporation, New York, Usa). Alpha levels were set at 0.05 (95% conviction level).

RESULTS

Participants

Sixty-six dancers (females = 40, males = 26) aged between sixteen-24 years old (mean eighteen.15yrs, SD ane.45) gave consent to participate. There were 28 dancers in year i, 25 in year two and 13 in twelvemonth three. Thirty-two were ballet majors and 34 were modernistic majors. Seventy-seven per cent of dancers attention the trip the light fantastic school participated in the report. During the course of the study one dancer opted out of reported injury information collection and 4 dancers left the school. Demographic characteristics of participants are presented in Table 1.

Tabular array 1.

Demographic data, reported as mean (SD)

	Full Sample	Females	Males	p-value
Subjects (n)	66	xl	26
Age (years)	18.15 (1.45) (range: 16 - 24)	17.78 (1.18) (range: 16 - xx)	18.57 (1.72) (range: xvi - 24)	0.054
Weight (kg)	59.79 (9.67)	53.93 (6.04)	68.81 (6.29)	<0.001*
Height (cm)	171.17 (9.35)	165.63 (half dozen.52)	179.75 (v.88)	<0.001*
BMI	20.25 (1.88)	19.54 (1.74)	21.33 (1.52)	<0.001*
Age started dancing (yrs)	11.83 (three.39)	11.56 (3.xvi)	12.24 (three.76)	0.442

Injury Prevalence

Fifty-seven (86.4%) dancers reported a history of previous trip the light fantastic related injury at the outset of the study. A total of 125 reported injuries, involving 56 dancers (86.two%), were recorded over the academic year. Injury prevalence across the twelvemonth ranged from 1.5% to 36.9% per calendar month. No significant demographic differences were found between dancers who reported whatsoever injury or time-loss injuries and those who did not (Tabular array 2).

Table 2.

Descriptive characteristics of injured and non-injured groups

	Injury reported		No injury reported Mean		p-value
	Mean	Mean	(SD)	(SD)
North	56		9
Historic period (years)	18.23	(1.47)	17.77	(1.30)	0.388
Top (cm)	170.66	(9.36)	173.33	(9.50)	0.432
Weight (kg)	59.23	(9.43)	62.88	(11.58)	0.299
BMI	20.25	(i.87)	20.31	(2.00)	0.935

	Injury reported		No injury reported		p-value
	North	(%)	North	(%)
Previous history injury	49	(87.5%)	eight	(88%)	0.600†
Electric current injury	10	(17.9%)	1	(12%)	1.000†
Gender
Male	22	(39.3%)	three	(33.3%)	1.000†
Female	34	(lx.7%)	6	(66.half-dozen%)
Major
Ballet	27	(48.2%)	five	(55.vi%)	ane.000†
Modern	29	(51.8%)	4	(44.iv%)
Year of preparation
1st	23	(41.1%)	four	(44.iv%)	0.902†
2nd	21	(37.5%)	4	(44.four%)
3rd	12	(21.4%)	1	(11.1%)

Injury Characteristics

Reported injury characteristics are shown in Table three. The ankle was the most mutual site of lower limb injury, followed by the genu, foot, and hip/thigh respectively. The thoracic spine was the most common site of body injury, followed by the lumbar spine. The shoulder was the most common upper limb injury.

Table 3.

Characteristics and severity of reported and self-reported injuries

Characteristics	Reported Injuries north	%
Full injuries	125
% dancers injured		86.2
New	104	83
Recurrent	21	16.viii
- Re injury	viii	38.1
- Exacerbation	13	61.9
Astute	51	40.8
Overuse	74	59.2
Head/Neck	4	3.2
Trunk	25	20
Lower Limb	85	68
Upper Limb	11	eight.eight

Injury Severity	Reported as mean (SD) or n	%
Hateful numerical pain score	v.29 (1.91)
Time-loss injuries:	n=74	59.2
Total days off dance	v.85 (6.37) (range: one - 42 days)
Not time-loss injuries:	n = 51	twoscore.8
Days of modified activity	7.14 (5.49) (range: 0 - 28 days)
Activity modification:
none	n=1	2
balmy	north=vii	xiv
moderate	n=43	84
astringent	north=0	0

Injury Severity

Of all reported injuries, 59.2% (n=74) were time-loss resulting in a total of 433 full days off dance. Fourscore-six per cent (n=64) of all time-loss injuries required the dancer to have ≤ 7 days off dance (S2), with 13.5% (n=10) taking > 7 days off dance (S3). Injuries requiring the greatest time off dance included: lower limb stress fractures, posterior cruciate and meniscal injury, and tendon injuries of the foot and ankle. The distribution of injury severity via injury location is presented in Figure 1.

Location severity of reported injuries.

Injury Incidence

The total injury incidence rate over the academic yr was 2.27 (95% CI 2.25-2.28) per chiliad dance exposure hours (DEhr) and 3.35 (95% CI iii.33-iii.37) per yard trip the light fantastic toe exposures (DE). The total injury incidence for fourth dimension-loss injuries was i.34/1000DEhr and one.98/1000DE's. The injury incidence rates, for reported injuries were similar for males and females (2.39 and two.19/1000DEhr), and ballet and modernistic dancers (2.11 and ii.17/1000DEhr). Offset year students had the highest injury incidence rate for reported injuries (2.95/1000DEhr). Injury incidence as well decreased term-by-term, with the highest incidence in term one (3.sixty/1000DEhr). Injury incidence (DEhr and DE) for reported injuries is presented in Tables 4 and ​ 5.

Table 4.

Injury incidence rates for reported injuries per dance exposure hours (DEhr)

Variable	Subjects		Total Injuries	Total DEhr	Mean DEhr	SD	95% CI	Reported Injuries per g DEhr
	Northward	%	RI						95%CI
Yr 1	27	41.5	59	20021	741:30	180:00	670:16 – 812:43	2.95	2.92 – ii.97
Twelvemonth 2	25	38.v	44	22733	909:xix	148:22	848:04 – 970:33	i.94	1.92 – 1.95
Yr 3	13	twenty.0	22	12408	954:26	86:58	901:52 – 1006:59	1.77	1.75 – 1.79
Male person	25	38.five	50	20930	837:11	206:31	751:56 – 922:26	2.39	2.37 – two.41
Female person	twoscore	61.5	75	34232	855:46	158:34	805:46 – 906:29	2.19	two.eighteen – 2.21
Ballet	31	47.7	58	27434	784:40	217:03	705:03 – 846:17	2.11	two.10 – ii.xiii
Modern	34	52.iii	67	30836	906:57	103:32	870:44 – 943:04	2.17	ii.sixteen – 2.19
Time-Loss	43	66.one	74	55162	848:33	177:12	804:43 – 892:32	1.34	1.33 – 1.35
Non Time-Loss	35	53.8	51	55162	848:33	177:12	804:43 – 892:32	0.92	0.91 – 0.93
Total Cohort	65	100.0	125	55162	848:33	177:12	804:43 – 892:32	two.27	2.25 – 2.28

Table 5.

Injury incidence rates for reported injuries per number of dance exposures (DE)

Variable	Subjects		Total Injuries	Total DE	Mean DE	SD	95% CI	Reported Injuries per 1000 DE
	N	%	RI						95%CI
Year 1	27	41.v	59	13771	510.04	142.79	453.55 – 566.52	iv.28	4.25 – 4.32
Yr 2	25	38.5	44	15258	610.32	100.75	568.73 – 651.91	2.88	ii.86 – 2.91
Twelvemonth 3	xiii	twenty.0	22	8285	637.31	25.62	621.82 – 652.00	2.66	two.62 – 2.69
Male	25	38.v	50	14113	564.52	140.50	506.52 – 622.52	3.54	3.51 – three.57
Female	40	61.five	75	23201	580.03	113.19	543.82 – 616.22	iii.23	three.21 – 3.26
Ballet	31	47.7	58	17138	552.83	167.86	491.26 – 614.41	3.38	3.36 – 3.41
Modernistic	34	52.three	67	20176	593.41	56.43	573.72 – 613.10	3.32	3.29 – 3.35
Fourth dimension-Loss	43	66.ane	74	37314	574.06	123.57	543.44 – 604.68	1.98	1.97 – 1.99
Not Fourth dimension-Loss	35	53.viii	51	37314	574.06	123.57	543.44 – 604.68	one.37	one.35 – one.38
Total Accomplice	65	100.0	125	37314	574.06	123.57	543.44 – 604.68	3.35	3.33 – 3.37

Relationship between trip the light fantastic toe exposure and injury

The total number of trip the light fantastic exposures (DE) per calendar month was significantly associated with the total number of reported injuries reported per month (p=0.016) (Effigy ii). A significant clan was too plant between the average number of dance exposures (DE) per dancer per month and the total number of injuries per month (p=0.027). The total hours of trip the light fantastic exposure (DEhr) was found not to be a significant predictor of injury (p=0.964).

Dance exposure and injury.

Human relationship between reported injuries and risk factors

The association between potential risk factors and injury is presented in Tabular array 6. A MCS score < 23 was significantly associated with increased risk of injury (p=0.035). Furthermore, the higher number of injuries in those with a MCS score <23 was more than likely to be explained by a greater number of torso injuries (p=0.036). No significant divergence in full MCS scores was found for age, gender, major, or yr group (p>0.05).

Tabular array half-dozen

Association between the total number of reported injuries and adventure factors

Independent Variables	Adjusted R Square	B	95% CI	p-value
Historic period	−0.016	−0.001	−0.235 – 0.233	0.992
BMI	−0.013	0.039	−0.141 – 0.220	0.667
Gender	−0.014	−0.125	−0.817 – 0.567	0.720
Major	−0.014	−0.100	−0.774 – 0.575	0.769
Year of preparation	0.008	−0.272	−0.714 – 0.169	0.222
Total MCS score	0.022	−0.081	−0.186 – 0.023	0.125
Hateful MCS score	0.054	−0.702	−one.354 – −0.050	0.035*
Previous Injury	0.016	−0.685	−1.646 – 0.277	0.160

A history of previous injury was found not to be associated with increased injury risk. However, a significant association between previous history of injury and gender was noted, whereby more females had sustained previous injuries compared to males (p=0.022). A meaning association was found betwixt injury location and major, whereby modern majors were more likely than ballet majors to sustain trunk injuries (B=-0.304, p=0.042) and upper limb injuries (B=0.324, p=0.001). Upper limb injuries were more mutual amid first year students, decreasing for every year of study (B=-0.152, p=0.025).

Word

Participants

The key strengths of this prospective report included: (1) 70-seven per cent of eligible dancers participated in the study, (2) the use of reported injury and exposure data collected over a full academic year and, (three) this is the start prospective longitudinal study of elite pre-professional dancers in New Zealand.

Prevalence, incidence and severity

Prevalence

At the kickoff of the study 86% (n=57) of dancers reported a previous history of dance-related injury. This was comparable with previous studies (82-95%).^17,18,62,63 The injury prevalence over the academic year was (86.2%), which was within the upper range reported in current literature (30-94%).^{2,seven,8,10-12,sixteen,18,63} Further to this, 21% of injuries sustained were considered 'recurrent', viii% of which were re-injuries. This was fewer than that reported by Ekegren, Quested, Brodrick⁷ where 14% of time-loss injuries were considered a re-injury. Hereafter enquiry utilizing the Subsequent Injury Categorization (SIC) model equally proposed by Finch and Marshall⁶⁴ may enable a better agreement between injury and each subsequent injury; which tin can take a considerable bear on on a dancer'southward training and career.^nineteen,65

Incidence

Prospective studies utilizing reported injury data and a mixed cohort with which to compare the overall results of this study are defective. The incidence of reported injuries for ballet majors alone was ii.11/1000DEhr, which although comparable with previous studies, is at the upper finish of the range (range: 0.nine-2.9/1000hrs).^{11,sixteen,xviii} Fewer studies accept reported the injury incidence for modern dance students. In this written report the injury incidence (two.17/thou) was somewhat lower than the 4/1000hours of trip the light fantastic toe reported amongst modern dancers at the Escuela Nacional de Danza in Mexico.¹³ Comparisons betwixt dance schools should, however, be fabricated with caution as differences in demands, nature of exposures, and age of dancers may also affect on injury rates.

The findings of this study back up current bear witness that overuse injuries are a significant issue for dancers.^{2,7,11,sixteen,17,66,67} The incidence of overuse injuries was found to be lower than that reported in a contempo study of pre-professional person ballet dancers (2.4/10000DEhr and 3.52/1000DE).^three The shorter inception period of the compared study (6 months) and unmarried genre cohort may contribute to these differences. Comparatively, Ekegren, Quested, Brodrick⁷ reported a higher prevalence of overuse injuries (72%) compared to this current study (59.2%). The higher boilerplate dance exposure per year (1030hr) may exist a contributing factor, whereby longer training hours, with less relative fourth dimension for recovery is considered a meaning extrinsic risk cistron for sustaining overuse injuries.^25,68

Severity

Severity of injuries among pre-professional dancers has, thus far, been infrequently reported and the unlike measures utilized to define injury severity have also limited comparisons. The injury incidence for time-loss injuries in this study was comparable with findings from a recent prospective written report of 266 pre-professional ballet dancers in London that utilised the same time-loss injury definition (1.38/1000DEhr, 1.87/1000DE).^vii The current study found the bulk of injuries to be classified as S2 (≤7 days off dance). Although a recent study of pre-professional ballet dancers classified the majority of injuries as S1 (activity modification), this only included overuse injuries of the lumbar spine and lower limb which is likely to contribute to this difference.^three

Relationship between dance exposure and injury gamble

A significant finding in this report was that the full number of dance exposures was found to exist more highly associated with injury risk than the total hours of dance exposure. At that place is considerable potential for variation in volume, intensity, technical demand and nature of exposures during a dancers day/calendar week/term and year.⁶⁹ It may be hypothesized that this tin event in significant fluctuations in need, over training or indeed under training the dancer and, hence, contribute to injury take a chance. Optimizing dance schedules using periodization have been reported to be an effective strategy in reducing injury risk and drop out rates in a pre-professional dance school,^seventy and to meliorate mood states prior to performance in professional person dancers.³¹ The findings of this enquiry back up further investigation into strategies to optimize training outcomes and minimizing injury risk for pre-professional dancers.^30,34,69

Current evidence indicates that rapid changes in training load precede the onset of injury.^29,71 This is consistent with findings in this study, whereby a greater number of reported injuries were sustained in term one (after the vacation period), peaking again after returning from each semester break. Current literature suggests that high astute:chronic workload ratios may contribute to increased run a risk of injury.^71,72 Although further research is necessary, this may be a factor contributing to the findings in this study. This report found the number of reported injuries decreased as the year progressed despite a relatively consistent book of exposure each term. Unlike previous research, assessments periods and increased exposure to rehearsal and operation (at the terminate of the twelvemonth) did non issue in a higher number of reported injuries.^16,30 Information technology may be that as the year progressed dancers were improve conditioned to meet their demands and therefore more resilient and accustomed to the workload, or simply reported fewer injuries to avoid missing vital cess and performance opportunities.⁷³ In contrast to previous research, the year of pre-professional training was not associated with increased injury risk, despite increasing dance exposure.^seven It is possible that emerging adolescent dancers take a lower threshold for injury, every bit has been reported for other sports.⁷⁴ The small cohort and, specifically, the express number of 3rd year dancers in this study may take contributed to this finding. Further research investigating the dose-response relationship between preparation and injury and workload ratios beyond differing age groups and genres is needed.

Relationship between injury and take chances factors

A primary aim of this study was to establish the relationship between the Movement Competency Screen (MCS), and injury chance. MCS scores were analyzed both as a continuous (full MCS score) and categorical (mean MCS score) variables. The mean (and median) MCS score for this cohort was 23, and this was used to ascertain the categorical variables group assignment (i= < 23, ii = ≥23). Those dancers who scored beneath the hateful (<23) were considered to demonstrate reduced or altered move control during functional motility patterns, beyond that which was typically seen within the cohort. Utilizing the mean MCS score as a cut off score enabled comparisons with previous research of movement screening tools, which accept also utilized dichotomized pass/fail scores. In this study dancers who scored less than 23 were more probable to sustain an injury than those who scored at or higher up 23 (p=0.035). This suggests that those dancers who demonstrated reduced or altered movement control during functional motion patterns, beyond what was typically seen within the cohort, may be more than susceptible to time to come injury. This provides some back up for the inclusion of the MCS as role of an overall injury screening strategy, whereby those dancers who may benefit from farther assessment, conditioning or load modification tin be identified in a timely manner. No other studies utilizing the MCS, inclusive of dynamic jump tasks, were identified in the literature, although a recent prospective study of aristocracy rowers in New Zealand did investigate the relationship between the total MCS score (five fundamental movements merely) and risk of lower back injury.^51,75 The authors of that study found rowers who scored at or higher than the mean MCS score were more likely to develop low back hurting compared to those who scored lower, however, this finding was not statistically meaning (OR=2.57, p=0.07). Studies evaluating the efficacy of other functional move screening tools to identify those at risk of injury accept also reported positive associations. The most reported tool to do so is the Functional Motility Screen (FMS^TM).^76-lxxx In spite of this, the efficacy of the FMS^TM to predict injury risk should be considered in the context of those studies where no association and bimodal associations take been found.^81-83 The variability presented within the enquiry highlights the difficulty of utilizing cut-off scores for predicting injury risk, where the sensitivity of the cutting-off score is inversely related to the specificity.⁸⁴ While a single screening tool solitary is unlikely to identify all those at take a chance of injury, identifying the most effective and efficient tools which detect factors that contribute to the injury risk profile of dancers is essential. The MCS has the potential to be utilized more than widely past dance teachers, strength and conditioning coaches, and healthcare providers, and to educate dancers as part of an injury prevention strategy.

The findings of this report back up the evolution of injury prevention programs targeting neuromuscular control in those with identified deficits. A recent three-twelvemonth prospective study utilized the functional motility screen (FMS^TM) to guide the development of individualized conditioning programmes for a group of professional ballet dancers. ⁸⁵ This resulted in a significant reduction in all injuries equally well as recurrent injury over the three years. Every bit injury prevalence has been shown to be high amongst adolescent dancers, specifically lower limb injuries, injury prevention programes involving neuromuscular control aimed at the broader adolescent dance population may have the biggest impact in reducing injury adventure.

Limitations of the study

Estimation of these results should exist considered aslope the following methodological limitations. The sample size in this study was pocket-sized due to the limited number of dancers attention the dance school, and as a outcome the relationship between some gamble factors and injury is unclear.⁸⁶ The loss of five dancers during the course of the study may have also affected observed associations. Furthermore, although statistical assay demonstrated an clan betwixt the mean MCS score and injury, there are withal a lot of unknown factors that contribute to these injuries. This was highlighted by the very low adjusted R-squared value (R² = 0.054) (see Table 6). Further research is therefore nonetheless required to identify other possible hazard factors for these injuries. The number of days of modified activity for time-loss injuries was not included and should exist taken into consideration when interpreting the affect and severity of time-loss injuries on dance participation. The intensity and nature of dance exposures, and workload ratios was not included in exposure analysis. These factors may impact on the potential injury run a risk of individual dancers. Dance exposure was calculated each week from the timetables, for each year grouping (major and gender), but non individually, hence may not truly reverberate the actual hours of training or engagement by each individual dancer. Non-scheduled trip the light fantastic practice or additional workouts such as attending the gym, were also not included in the total hours of trip the light fantastic. As the dancers progressed through the year their movement competency may have changed, and also their injury take chances in relation to MCS scores. Research undertaking screening at more regular intervals over the twelvemonth may meliorate establish the relationship between outcomes scores and injury risk.

Functional move screening has the chapters to identify dancers at risk of injury. Every bit such, future intervention studies targeting those at risk individuals/groups with focused prevention/workout programmes are indicated. Multicentre studies examining preparation loads (acute and chronic) and nature of exposures in relation to injury hazard are necessary to optimise preparation and operation outcomes across differing historic period groups and genres. Hereafter research is needed to examine if MCS scores taken at regular intervals during the year may exist more useful in establishing injury run a risk. Research establishing the inter-rater reliability of the MCS is necessary for this tool to exist useful between providers and across the broader population.

Decision

This is the commencement prospective longitudinal study of pre-professional dancers in New Zealand. Injury prevalence and incidence rates were high, although comparable to those reported internationally. The results of this study betoken, that the number of dance exposures was more than highly associated with injury risk than the hours of dance exposure. Furthermore, dancers had a greater chance of sustaining injury in term ane, reducing with each term of the yr. At that place is a need for further prospective longitudinal studies examining trip the light fantastic exposure and the human relationship to injury. An MCS score < 23 was associated with an increased gamble of futurity injury. Therefore, including the MCS every bit function of an overall injury screening strategy may be an efficient and effective strategy to aid identify those dancers who could benefit from focused injury prevention strategies.

APPENDIX one

APPENDIX two

Injury and severity definitions

Definitions utilised for injury recording and associated variables include:

Injury: Any physical complaint sustained by a dancer resulting from functioning, 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 ⁵³.

Fourth dimension-Loss Injury: "an anatomic tissue-level impairment as diagnosed by a registered health care practitioner that results in full time loss from activity for one or more than days beyond the day of onset" ⁵⁸.

Not Time-Loss Injury: An injury that does not rising to the level of a reported fourth dimension-loss injury ⁵⁸.

Reported Injury: Any injury (time-loss or not fourth dimension-loss) coming together the injury definition which was triaged, assessed or managed by the NZSD physiotherapist.

Cocky-Reported Injury: Whatever injury meeting the injury definition (time-loss or non fourth dimension-loss), reported via online questionnaire directly from the trip the light fantastic pupil.

Traumatic/Acute Injury: "An injury that results from a specific identifiable event" ⁸⁴.

Overuse Injury: "An injury caused by repeated micro-trauma without a single identifiable event responsible for the injury" ⁸⁴.

Recurrent Injury: An injury with the same diagnosis as a previously recorded injury and that occurs within two months after the dancer'southward return to full participation ^55,82. Recurrent injuries were further categorised according to Fuller et al (2007) as either:

1. 1. Exacerbations: "worsening state of a non-recovered injury such that the dancer is unable to take a total part in trip the light fantastic toe related activities that would unremarkably be required" ⁸².

2. 2. Re-Injury: "an injury of the same type and at the same site as the beginning episode, occurring after a dancers return to total participation from the initial injury inside two months" ⁸².

Injury severity was measured by time-loss (days) or degree of activity modification and were divers as:

Time-loss: is the full number of total days off trip the light fantastic, from the date of injury to the engagement of the dancer returning to participation ⁵⁷.

Activity Modification: is the extent to which a dancer had to alter or reduce their training load due injury. This was rated using a descriptive scale, describing the degree of activity modification the dancer had to undertake as a consequence of the injury as listed below.

1. Not at all: dancer is able to attend all classes/rehearsals/performance, without any limitations

2. Small: dancer is able to nourish all classes/rehearsals/performance with just small limitations

3. Moderate: dancer is able to attend all classes/rehearsals/performance just with moderate limitations such as; participating in petite allegro but not 1000 allegro, keeping legs below 45 degrees

4. Major: dancer is unable to participate in significant components of classes/rehearsals/functioning, including having to sit out some only not all timetabled classes over a normal school twenty-four hour period or fugitive significant components such equally jumping or pointe work

Injury severity was also coded based on definitions adapted from previous research past Dick, Agel, Marshall ⁵⁷ and Bowerman ⁶⁴

S0 No days off or modified

S1 Activity modification only

S2 ≤ seven days off dance

S3 > vii days off trip the light fantastic toe

S4 Yr ending - if a dancer was unable to return to preparation due to injury

APPENDIX iii

Movement Competency Screen Testing Sequence

APPENDIX 4

APPENDIX 5

Move Competency Screen Scoring Criteria

Body Region/Capacity	MCS Job ane Torso Weight Squat	MSC Task 2 Counter Movement Jump	MSC Task 3 Lunge and Twist	MCS Job four Bilateral broad leap with unilateral land	MCS Task 5 Trunk weight unmarried leg squat	MCS Task 6 Counter movement jump off ii landing on one
Head	Held stable in a neutral position and centrally aligned
Shoulders	Held down and away from ears. Elbows appear in line with ears. Thoracic extension is evident	Held down away from ears. Elbows in line with ears.	Held down and away from ears. Rotation appears to occur through thoracic spine. Elbows is at least inline with the pb human knee at end range of rotation	Held down abroad from ears.	Held down away from ears. Elbows in line with ears. Thoracic extension is clear	Shoulders held downwards abroad from ears. Elbows in line with ears.
Lumbar	Neutral bend	Maintains lumbar curve, no hyperextension, rotation or flexion	Held stable, neutral spine is maintained through out rotation. Rotation and/or lateral flexion does not occur about the lumbar region during trunk rotation	Maintains lumbar curve, no hyperextension, rotation or flexion	Held stable in a neutral spine position throughout lower limb flexion and extension	Maintains lumbar bend, no hyperextension, rotation or flexion
Hips	Movement is initiated with hip flexion. Remain horizontally aligned during flexion and extension. Manifestly moving back and downwardly during flexion		Horizontally aligned, mobile and stable to prohibit acme and depression during rotation	Horizontally aligned and stable to minimize superlative and low during landing	Movement is initiated with hip flexion. Remain horizontally aligned during flexion and extension. Clearly moving dorsum and downwardly during flexion, minimal weight shift over stand leg.
Knees	Aligned with hips and feet during flexion		Aligned with hips and feet during flexion and do non move laterally with rotation	Aligned with hips and feet	Aligned with the hip and foot during flexion and extension	Aligned with hips and feet
Ankles	Mobility allow adequate dorsiflexion during knee and hip flexion
Feet	Stable with heels grounded during lower limb flexion		Heel of lead leg in contact with the flooring, trail foot flexed and counterbalanced on forefoot	Stable	Stable with heels grounded during lower limb flexion
Balance		Evenly distributed	Maintained on each leg	Able to control and stick landing	Maintained on each leg	Able to control stick landing
Depth	90 degrees or greater of hip flexion	seventy degrees or greater of hip flexion	Pb thigh parallel to the floor	seventy degrees of hip flexion	70 degrees of hip flexion	70 degrees of hip flexion

Body Region/Capacity	MCS Task 7 Bend and Pull	MSC Task eight Press upward
Head	Held stable in a neutral position
Shoulders	Held downwards abroad from ears during arm flexion and extension. Scapulae move balanced and rhythmic and are not excessively abducted at arm extension	Held down and away from ears during arm flexion and extension. Scapulae motion counterbalanced and rhythmic and are not excessively abducted at arm extension
Lumbar	Held stable in neutral spine position throughout torso flexion and extension	Held in stable neutral spine position
Hips	Movement is initiated with hip flexion. Extension is obvious and controlled	Held in line with the body during arm flexion and extension
Knees	Neutral position and held stable	Extended and held stable
Ankles	NA	NA
Feet	Pointing directly	Feet direct, heels not falling in or out
Balance	Maintained	NA
Depth	75 - 90 degrees or greater of trunk flexion	Breast touches floor

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