Prevalence of Urinary Incontinence and Other Pelvic Floor-Related Symptoms in Female Professional Dancers.

INTRODUCTION: Urinary incontinence (UI) is a common issue in female athletes and is known to negatively impact quality of life and sport performance. However, the prevalence of UI in dancers has not been widely investigated. The purpose of this study was to assess the prevalence of UI as well as other symptoms of pelvic floor dysfunction in female professional dancers. METHODS: An anonymous online survey that included the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was developed and distributed via e-mail and social media. Two hundred and eight female professional dancers between the ages of 18 and 41 years (mean: 25.4 ± 5.2 years) who had a typical dance training and performance schedule of 25 hours or more per week completed the survey. RESULTS: A total of 34.6% of participants reported experiencing UI, with 31.9% of the dancers who reported UI reporting symptoms consistent with urge UI, 52.8% reporting UI with coughing or sneezing, and 54.2% reporting UI with physical activity or exercise. For those reporting UI, the mean ICIQ-UI SF score was 5.4 ± 2.5 points and the mean score for impact on everyday life was 2.9 ± 1.9. A report of pain with sexual activity and intercourse was significantly associated with presence of UI (p = 0.024), but the effect size was not notable (phi = 0.159). CONCLUSION: The prevalence of UI in female professional dancers is similar to that found in other high-level female athletes. Based on the notable prevalence of UI, health care professionals working with professional dancers should consider regularly screening for UI and other symptoms of pelvic floor dysfunction.

Effects of a "toes-off" modified heel raise on muscle coordination in non-dancers, dancers, and dancers with flexor hallucis longus tendinopathy.

BACKGROUND: Tendinopathy of the flexor hallucis longus, commonly called "dancer's tendinitis", is a prevalent injury among female ballet dancers. Limited success of non-surgical interventions leads to many dancers undergoing tenolysis surgeries with risks and recovery times that can be detrimental to a dance career. The purpose of this study was to evaluate lower limb kinematics and muscle coordination during a modified traditional heel raise exercise where the toes hang off the edge of the support surface. We hypothesized this would decrease activation of the flexor hallucis longus and increase activation of larger plantarflexors. METHODS: Healthy non-dancers (n = 11), healthy dancers (n = 10), and dancers with flexor hallucis longus tendinopathy (n = 9) performed traditional ("toes-on") and modified ("toes-off") heel raises with kinematic and electromyographic instrumentation of the lower leg. FINDINGS: Participants maintained ankle excursion with the toes-off modification, while metatarsophalangeal joints had reduced excursion and greater excursion variability. Most healthy dancers (9/10) decreased flexor hallucis longus activation as predicted, but dancers with flexor hallucis longus tendinopathy showed a variable response with some decreasing activation (3/9) but others increasing activation up to 4-times. There were no changes in activation of other plantarflexors. Across groups, intrinsic foot muscle activation decreased with the toes-off modification. INTERPRETATION: The toes-off modification decreased flexor hallucis longus activation in most of the healthy dancers but was insufficient to shift muscle coordination from the flexor hallucis longus to larger plantarflexors in dancers with flexor hallucis longus tendinopathy. Future work should investigate clinical cues or modifications to this "toes-off" heel raise intervention.

Postural cueing increases multifidus activation during stabilization exercise in participants with chronic and recurrent low back pain: An electromyographic study.

Persons with low back pain (LBP) have demonstrated altered morphology and function of the deep multifidus (DM). This study examined the effects of postural cueing for increased lumbar lordosis on DM and longissimus thoracis (LT) activation during lumbar stabilization exercises (LSE) performed by persons with LBP. Nine adults with a history of chronic or recurrent LBP were recruited. Fine-wire EMG data was collected while participants performed 10 LSE's in neutral posture and with postural cueing. Percent maximum voluntary isometric contraction of L5 DM and T12 LT, and ratios of activation (DM/LT) were analyzed. There was a significant main effect for posture on DM activation (p < 0.001), indicating greater activation levels during exercises performed with postural cueing vs. neutral posture. LT activation did not increase significantly with postural cueing. Following a significant 1-way repeated measures ANOVA (p = 0.034) for the postural cueing condition, pairwise comparisons demonstrated significantly higher DM/LT activation ratios for prone leg lift, variable-angle Roman chair at 15°, bridging, and bilateral arm and leg lift. These results suggest postural cueing can be used across a range of LSE intensities to increase DM activation without a significant increase in LT activation in patients with chronic or recurrent LBP.

Dancers with achilles tendinopathy demonstrate altered lower extremity takeoff kinematics.

STUDY DESIGN: Controlled laboratory study using a cross-sectional design. OBJECTIVES: To analyze lower extremity kinematics during takeoff of a "saut de chat" (leap) in dancers with and without a history of Achilles tendinopathy (AT). We hypothesized that dancers with AT would demonstrate different kinematic strategies compared to dancers without pathology, and that these differences would be prominent in the transverse and frontal planes. BACKGROUND: AT is a common injury experienced by dancers. Dance leaps such as the saut de chat place a large demand on the Achilles tendon. METHODS: Sixteen female dancers with and without a history of AT (mean ± SD age, 18.8 ± 1.2 years) participated. Three-dimensional kinematics at the hip, knee, and ankle were quantified for the takeoff of the saut de chat, using a motion analysis system. A force platform was used to determine braking and push-off phases of takeoff. Peak sagittal, frontal, and transverse plane joint positions during the braking and push-off phases of the takeoff were examined statistically. Independent samples t tests were used to evaluate group differences (α = .05). RESULTS: The dancers in the tendinopathy group demonstrated significantly higher peak hip adduction during the braking phase of takeoff (mean ± SD, 13.5° ± 6.1° versus 7.7° ± 4.2°; P = .046). During the push-off phase, dancers with AT demonstrated significantly more internal rotation at the knee (13.2° ± 5.2° versus 6.9° ± 4.9°; P = .024). CONCLUSION: Dancers with AT demonstrate increased peak transverse and frontal plane kinematics when performing the takeoff of a saut de chat. These larger displacements may be either causative or compensatory factors in the development of AT.