Relative energy deficiency in dance (RED-D): a consensus method approach to REDs in dance.

Relative energy deficiency in sport (REDs) is a potentially severe, challenging, broad-spectrum syndrome with potential negative health and performance outcomes. The numerous research publications and International Olympic Committee consensus statements relating to REDs testify to the challenges faced in early identification or screening, diagnosis and management. Like sport, dance, in its simplest form, can be identified as an activity resulting in physiological energy demands and, as such, requires appropriate energy availability concerning energy expenditures. However, the specificity of physiological and psychological demands in dance must be considered when considering REDs. An environment where physical activity can exceed 30 hours per week and where culture may instil a value that thinness is required puts dancers at increased risk for REDs. The purpose of this study was to provide dance-specific guidance dance on this complex condition. An RAND/UCLA Delphi Panel method with nominal group technique was used to review the literature from REDs to evaluate how it may relate to dance. In addition to the EP, which was assembled from a multidisciplinary background with expertise in REDs and multiple genres of dance, six focus groups were commissioned. Four of the focus groups were drawn from the EP members and two additional focus groups formed by dancers and artistic leaders. These panels were used to guide the development of a RED-D diagnosis pathway, management plan and risk stratification and return to dance pathway. The dance-specific pathways are designed to be a practical tool for guiding and supporting clinicians managing RED-D. Furthermore, this paper represents an important focus of this area in dance and serves to stimulate discussion and further research within the sector.

Injury Patterns in Hip Hop Dancers.

Hip hop dance is becoming increasingly popular. It is performed in a variety of environments and can be fused with other dance styles. There is limited research on this dance demographic. The object of this study was to record and assess the injury patterns and diagnoses of hip hop dancers who presented to a dancer injury clinic at the Royal National Orthopaedic Hospital (RNOH) in London over a 5-year period. Of the 800 patients who attended the clinic, 73 (28 males, 45 females) identified themselves as hip hop dancers. The mean age of these dancers was 26.1 years (± 6.59 years). The majority were professionals (49%) and the next largest group was students (31.5%). The most common site of injury was the knee (36%), followed by the lumbar spine (19%) and the foot and ankle (15%). The site of injury appeared to be influenced by the sub-style of hip hop the dancer performed. There were gender differences in knee injuries; male dancers predominantly sustained meniscal injuries (45%) and female dancers primarily sustained patellofemoral pain (60%). All lumbar disc injuries were at the L5/S1 level. These results are comparable to those of previous studies investigating injury in hip hop dancers. More research is needed to explore injury etiology, develop injury prevention measures, and increase awareness of the injury complexities in this dance population.

Effect of Vitamin D on Muscle Function and Injury in Elite Adolescent Dancers: A Randomized Double-Blind Study.

PURPOSE: A number of studies have noted low levels of vitamin D in dancers, and this has been associated with increased risk of injuries and decreased muscle-strength indices. The aim of the present study was to examine whether vitamin D supplementation over a 4-mo period can improve muscle function and injury incidence. METHODS: A total of 84 participants volunteered; exclusion criteria and dropout (19%) reduced the cohort to 67 participants (females = 29 and males = 38; 17-19 y). Participants were randomly assigned to either an intervention or placebo group (2∶1 ratio). All provided a venous blood sample before and after the 4-mo study period. The intervention group received 120,000 IU vitamin D to be taken over a 1-wk period, and the placebo group received the same number of inert pills. Participants completed a series of muscle function tests before and after the monitoring period. Injury incidence was recorded by the independent health team at the school. RESULTS: Preintervention, 6% of the cohort were vitamin D deficient, 81% were insufficient, and 13% had sufficient levels; postintervention, 53% were insufficient and 47% were sufficient. The intervention group reported a significant increase in serum 25(OH)D3 (57%; P < .00) and isometric strength (7.8%; P = .022) but not muscle power. There was a significant association between traumatic injury occurrence for the intervention and control groups (10.9% vs 31.8%; P < .02). CONCLUSION: Vitamin D supplementation decreased the numbers of deficient and insufficient participants in this cohort. The intervention group reported a small significant increase in muscle strength that was negatively associated with traumatic injury occurrence.

The Relationship Between Range of Motion and Injuries in Adolescent Dancers and Sportspersons: A Systematic Review.

Background: The frequent and intensive training and performance of pre-professional ballet dancers and sportspersons is offered at a time when young ballet dancers and young athletes may be vulnerable to injury due to the progress through adolescence and growth spurts. Hypothesis: There are changes in range of motion during the progress through adolescence and growth periods in dancers and sportspersons. These changes in ROM can be linked to the increase of injury. Objectives: The primary aim of this systematic review is to determine whether there are changes in ROM during the progress through adolescence and growth spurts in dancers and sportspersons. The secondary aim is to determine whether these changes can predict the risk of injuries for adolescent dancers and sportspersons. Search strategy: Pubmed, Cochrane Register of Controlled Trails (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), EBSCO Host databases: CINAHL Plus, MEDLINE, SPORTDiscus, Embase were searched using MeSH terms. Manual search in the Journal of Dance Medicine and Science and screening of the reference lists of identified studies and reviews was conducted. Selection criteria: Studies included adolescent dancers and sportspersons, aged 8-18, both sexes, growth spurt related to changes in ROM and injury incidence. Data collection and analysis: Search strategy was performed in the flow diagram of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers independently appraised each included study using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for methodological quality of the included studies. For data extraction, the following information was systematically extracted: first author and year of publication, study design, participants (sample size of mean age), age, maturation (if assessed), intervention, outcome(s), and some notes of each study. For evaluation of the risk of bias and precision the Research Triangle Institute Item Bank (RTI-IB) is included. Main results: Seven observational studies met the inclusion criteria of this current review. The results of this review suggest that there are changes in ROM during the progress through adolescence and growth spurts in dancers and sportspersons. These changes may lead to an increase in injury incidence. Conclusion: There is evidence linking to changes in ROM during the progress through adolescence and growth spurts in dancers and sportspersons. These changes in ROM may be related to injury incidence.

Orthopaedic management of the Ehlers-Danlos syndromes.

The role of orthopedic surgery in Ehlers-Danlos syndrome is inherently controversial, opaque to most patients and many medical providers, and difficult to discern from available medical literature. Non-operative treatment is preferable, but for carefully selected patients, specific joint stabilization and nerve decompression procedures can provide symptomatic relief when conservative measures fail. © 2017 Wiley Periodicals, Inc.

Acute Effects of Vitamin D3 Supplementation on Muscle Strength in Judoka Athletes: A Randomized Placebo-Controlled, Double-Blind Trial.

OBJECTIVE: Indoor athletes have been shown to be prone to vitamin D3 deficiency. The aim of the study was to examine the acute effects of vitamin D supplementation on muscle function using isokinetic dynamometry. DESIGN: Randomized placebo-controlled, double-blind study. SETTING: Institutional. PARTICIPANTS: Adult male white national level judoka athletes (n = 22) who were involved in full-time training. Exclusion criteria were vitamin supplementation, overseas travel to sunny climes, and/or an injury incurred during the last 3 months before testing. INTERVENTIONS: Subjects were randomly allocated to the treatment (150 000IU vitamin D3) or placebo and given blinded supplements by an independent researcher. Participants were tested twice, 8 days apart, on a Monday morning before the start of judo training and after 2 days of rest. A 5 to 7 mL of blood sample was collected followed by isokinetic concentric quadriceps and hamstring muscle function assessments on the right leg at 30 and 200°·s. MAIN OUTCOME MEASURES: Repeated-measures analysis of variance was used to analyze isokinetic muscle force and serum 25(OH)D3. Regression to the mean was used to examine changes in 25(OH)D3 levels over the study period. RESULTS: The treatment group demonstrated a significant increase in serum 25(OH)D levels (34%, P ≤ 0.001) and muscle strength (13%, P = 0.01) between days 1 and 8. No significant differences were found for the placebo group for the same period. CONCLUSIONS: A single bolus of 150 000IU vitamin D3 had a significant positive effect on serum 25(OH)D levels and muscle function in vitamin D insufficient elite indoor athletes. CLINICAL RELEVANCE: Serum 25(OH)D3 levels of indoor athletes should be monitored throughout the year and especially during winter months. Beneficial responses, in muscle strength and serum 25(OH)D3, to 1 dose of vitamin D3 supplementation can be observed within 1 week of ingestion. Muscle strength is linked to serum 25(OH)D levels.

The influence of winter vitamin D supplementation on muscle function and injury occurrence in elite ballet dancers: a controlled study.

OBJECTIVES: Athletes who train indoors during the winter months exhibit low serum 25-hydroxyvitamin D [25(OH)D] concentrations due to a lack of sunlight exposure. This has been linked to impaired exercise performance. The purpose of this study was to assess the effects of oral vitamin D3 supplementation on selected physical fitness and injury parameters in elite ballet dancers. DESIGN: Controlled prospective study. METHODS: 24 elite classical ballet dancers (intervention n=17; control n=7) participated in a controlled 4-month oral supplementation of vitamin D3 (2000 IU per day). Isometric muscular strength and vertical jump height were measured pre and post intervention. Injury occurrence during the intervention period was also recorded by the in-house medical team. Repeated measures ANOVA and Mann-Whitney-U statistical tests were used and significance was set at p ≤ 0.05. RESULTS: Significant increases were noted for the intervention group for isometric strength (18.7%, p<0.01) and vertical jump (7.1%, p<0.01). The intervention group also sustained significantly less injuries than the controls during the study period (p<0.01). CONCLUSIONS: Oral supplementation of vitamin D3 during the winter months has beneficial effects on muscular performance and injury occurrence in elite ballet dancers.

Quadriceps traumatic myositis ossificans in a football player: management with intravenous pamidronate.

Myositis ossificans (MO) can be a significant complication of traumatic muscle contusion. Bisphosphates have been used in management of heterotopic ossification after spinal cord injury, but there is a lack of evidence with respect to MO in the sporting population. We present a case of a 14-year-old male football player with posttraumatic quadriceps MO, treated with 2 doses of intravenous pamidronate. This was associated with improvement in clinical features and imaging and a reduced urinary N-terminal telopeptide, a marker of bone turnover. This case demonstrates that bisphosphonates may be a potential treatment option in MO.

Vitamin D status in professional ballet dancers: winter vs. summer.

OBJECTIVE: Serum 25-hydroxyvitamin D is produced by the exposure of the skin to sunlight. Therefore athletes who train indoors, such as dancers, are vulnerable to vitamin D deficiency. The purpose of the study was to evaluate the serum 25-hydroxyvitamin D status in UK professional dancers during periods of reduced and increased sunlight exposure (i.e., winter vs. summer), and to assess the impact on bone metabolism and risk of injury. DESIGN: Cohort study. METHODS: 19 elite classical ballet dancers (age 26±8.86yr; height 1.66±8.84m; mass 54.3±10.47kg) were monitored over a 6 month period for 25-hydroxyvitamin D, PTH and blood serum bone turnover markers (CTX and PINP) along with injury data. Repeated measure ANOVA and Wilcoxon and Chi-square analyses were used and significance was set at p≤0.05. RESULTS: Significant changes were noted between the winter and summer test dates for 25-hydroxyvitamin D (14.9ng/ml vs. 23.9ng/ml; p<0.001), PTH (38.7pg/ml vs. 26.3pg/ml; p<0.001) and PINP (89.9ng/ml vs. 67.6ng/ml; p<0.01). The oral contraceptive had a significant effect on serum 25-hydroxyvitamin D, PTH and CTX. Soft tissue injuries were significantly lower in summer compared to winter period (winter=24, summer=13; p<0.05). CONCLUSIONS: Professional ballerinas characterized by a high incidence of low serum 25-hydroxyvitamin D levels which improve marginally in the summer. These dancers also demonstrate a higher injury incidence in the winter. Oral contraception seems to increase serum 25-hydroxyvitamin D levels and has a positive effect on bone metabolism.

Changes in bone turnover markers during the close season in elite football (soccer) players.

OBJECTIVES: Bone turnover marker changes in response to physical activity are well documented. There is, however, little information on the extent and severity of skeletal de-conditioning in athletes in response to rest periods. This study analyses changes in markers of bone resorption and bone formation during the close season within the squad of an English Football Association Championship club. DESIGN: Evaluation was performed on the first team football squad just before the end of the 2007/2008 football season and again 8 weeks later before pre-season testing and training. METHOD: Bone resorption was measured by serum concentration of C-terminal telopeptide (CTx) and bone formation by serum concentration of the N-terminal propeptide of type I procollagen (PINP). Twenty football players aged from 18 to 36 years (mean 23.6 years) were included in the study. RESULTS: The mean change in CTx during the close season was +0.14 ng/ml (95% CI: 0.21 to 0.06, p=0.001). The mean change in PINP was -10.8 ng/ml (95% CI: -3.9 to -17.7, p=0.004). CONCLUSIONS: In professional football players, a close season rest of 8 weeks results in an increase in bone resorption and a decrease in bone formation markers. This imbalance between formation and resorption may have negative effects on bone mass and structure. Future research should focus on understanding the many factors that could contribute to the changes found in the study during the close season.

Casebook: chronic knee pain.

It is beyond the scope of this article to fully explore the many and varied causes of chronic knee pain, but we hope to have reminded the reader of some of the essential principles involved. The importance of a full history cannot be over-emphasised and particular attention should be paid to issues surrounding the mechanism of injury and the role of a patient's chosen sport in their life. The cases highlight the value of the involvement of a multi-disciplinary team including physiotherapists, podiatrists and dieticians. It is also usual to involve sports psychologists and team coaches/trainers at the higher levels of sport. An appreciation of normal biomechanics is necessary. There are several specialised tests used in the evaluation of knee pain and it is worthwhile spending some time with a physiotherapist or colleague with an interest in musculoskeletal medicine to learn and practice them.