The Evaluation of Strength, Flexibility, and Functional Performance in the Adolescent Ballet Dancer During Intensive Dance Training.

BACKGROUND: Adolescent ballet dancers have a higher incidence of injury than adult professional dancers. It is unclear which factors, including biomechanical changes related to intense dance training and/or the growth process itself, contribute to increased injury risk in this population. OBJECTIVE: To assess changes in strength, flexibility, and functional performance in adolescent ballet dancers during a summer intensive dance program. DESIGN: Prospective cohort study. SETTING: Performing arts school in a suburb of Massachusetts. PARTICIPANTS: A convenience sample of 58 male and female ballet dancers, 12 to 17 years old, was enrolled. One dancer did not have functional testing due to injury, but strength and range of motion results were included. METHODS: Paired sample t-test was used to evaluate changes in (1) strength: lower abdominal muscle strength evaluated by the Kendall double leg lowering test; (2) flexibility: passive range of motion in hip extensibility, hip internal rotation, hip external rotation, hip turnout, and ankle dorsiflexion; and (3) functional athletic and dance assessment: the star excursion balance test (SEBT), vertical jump test, and dance technique performing demi-plié and passé dance positions. MAIN OUTCOME MEASUREMENTS: Change in strength, flexibility, and functional dance measurements pre- and postsummer intensive dance training. RESULTS: Lower abdominal strength testing improved 11° on the Kendall test (P < .001); lower extremity passive flexibility was reduced in all tested ranges bilaterally. Dance technique, in performing demi-plié and passé dance positions, improved. More dancers demonstrated correct knee alignment during demi-plié (P < .001-.002) and hip alignment during plié (P = .01-.04). Dancers also had greater active hip turnout in first position passé of 2 to 3° (P = .02-.05). No significant change was found in functional athletic performance as measured by the SEBT and vertical jump test. CONCLUSION: Adolescent dancers in this study cohort who participated in a summer intensive dance program improved lower abdominal muscle strength as well as functional dance technique in demonstrating correct alignment performing demi-plié and passé dance positions despite a decrease in passive lower extremity range of motion. Further research is needed to clarify the role of these findings in training for young dancers in order to move forward injury prevention efforts. LEVEL OF EVIDENCE: II.

Pediatric Dance Injuries: A Cross-Sectional Epidemiological Study.

OBJECTIVE: The purpose of this study was to analyze characteristics of dance injuries evaluated by sports medicine physicians. DESIGN: A cross-sectional epidemiological study of a 5% random probability sample of patients presenting for sports medicine evaluation between January 1, 2000, and December 31, 2009. SETTING: Sports medicine clinic of a tertiary-level pediatric medical center. PATIENTS: A total of 181 pediatric dancers (171 female and 10 male; 14.8 ± 2.0 years of age) with 222 injuries. MAIN OUTCOME MEASURES: Injury diagnoses, location, type, and treatment. RESULTS: Forty-six injury diagnoses were recorded in this random sample of pediatric dancers, with the most common being tendonitis/tendinopathy, patellofemoral pain syndrome, apophysitis, ankle impingement syndrome, and hip labral tear. Most of the injuries occurred in the lower extremities, with knee and ankle injuries being the most common. Injury classification by type revealed that joints were the body structure most likely to be injured, followed by soft tissues, skeletal elements, and growth plates. The most frequent joint injury was patellofemoral pain syndrome. The most frequent soft tissue injury was tendonitis/tendinopathy. The most common skeletal injury was a pars stress reaction/spondylolysis. The most common physeal injury was apophysitis. Dancers were treated mainly with physical therapy, surgery, or physical therapy, in addition to orthotics. CONCLUSION: Pediatric dancers experienced significant, and occasionally rare, injuries that may have long-term health consequences. Although injuries occurred mostly in the lower extremities and involved mainly joints, the most common specific diagnosis was tendonitis/tendinopathy. There is still much to learn about the management of dancers, and there is a need for further research into injury prevention, diagnosis, and treatment.

Etiology and body area of injuries in young female dancers presenting to sports medicine clinic: A comparison by age group.

INTRODUCTION: Improving knowledge regarding injuries sustained by pediatric dancers is important in order to better understand injury risk. The aim of this study is to analyze dance injury etiology and body area by age in a cohort of young female dancers presenting to a pediatric sports/dance medicine clinic. METHODS: The cross-sectional epidemiological study of a 5% probability sample of dancers evaluated between 1/1/2000 and 12/31/2009 with a musculoskeletal injury requiring physician evaluation. A total of 2,133 charts were reviewed from which 171 female dancers 8-17 years old (mean age 14.7 years) were identified. Data were stratified by age, < 12 years and ≥ 12 years, and analyzed based on injury body area, type, and etiology. Fisher's exact test was used to determine statistical significance. RESULTS: Injuries sustained by dancers in the younger age category (< 12 years) were largely to the foot-ankle/lower leg/knee (93.3%) versus thigh-hip/spine/upper extremity (6.7%). In comparison, dancers in the older age group (≥ 12 years) had a large proportion of injuries to the foot-ankle/lower leg/knee (67.3%) as well, but had a notably larger fraction of injuries to the thigh-hip/spine/upper extremity (32.7%; p = 0.04). Approximately two-thirds of the injuries sustained in the younger age group (< 12 years) were classified as bony. In comparison, injuries in the older age group (≥ 12 years) were roughly half bony and half soft tissue (51.3% and 48.7%, respectively; p = 0.29). Most injuries were overuse in etiology for both younger and older age groups (86.7% and 82.1%, respectively; p = 1.00). Through puberty, there was a decline in the injuries to the foot-ankle/lower leg/knee. Conversely, there was an increase in the thigh/hip-pelvis/spine/upper extremity injuries through growth. CONCLUSIONS: Injuries to young female dancers in this study cohort were mostly categorized as overuse in etiology, and differed by the age group and the body area. Increased information regarding dance injuries can help guide future injury prevention efforts.

Chilaiditi syndrome precipitated by colonoscopy: a case report and review of the literature.

Chilaiditi syndrome is a rare condition defined by the presence of gastrointestinal symptoms associated with the radiological finding of segmental interposition of the bowel between the liver and the diaphragm. While it is infrequently indentified as a source of abdominal pain, Chilaiditi syndrome carries clinical significance as it can lead to a number of serious complications including intestinal obstruction, perforation, and ischemia. A 58-year-old woman presented with Chilaiditi syndrome immediately following colonoscopic evaluation. Conservative measures failed to alleviate the patient's symptoms, and the patient ultimately elected to have operative management. Pexy of the cecum and ascending colon led to full resolution of her symptoms. To our knowledge, this is the first documented case of Chilaiditi syndrome iatrogenically induced by colonoscopy. Identification of this syndrome as a complication of colonoscopy and a source of post-procedural pain bears significance for providers involved in the peri-operative care of patients with factors predisposing them to the development of this condition.