Prevention requires team approach
By Hank Black
The inclusion of physicians, including specialists in pediatric orthopedic surgery and sports or dance medicine, in a team with teachers, physical therapists, parents, and others could help identify and prevent injuries in growing young dancers, according to authors of an epidemiological study of pediatric dance injuries published August 28 in Physical Medicine & Rehabilitation.
Lead study author Amy X. Yin, MD, noted empirical data on specific pediatric dance injuries are lacking, possibly because many young dancers don’t seek early medical advice and rely more on advice from dance teachers and physical therapists. While nearly all professional dancers seek medical attention for injuries, up to 30% of young dancers do not, said Yin, who completed the study while she was a fellow physician of sports medicine at Stanford University in California.
She and her colleagues analyzed dance injuries from a sample of children and adolescents aged 5 to 17 years seen over 10 years by sports and dance medicine physicians at a tertiary pediatric medical center. They looked at 181 dancers (171 girls, aged 14.8 ± 2 years) with 216 classifiable injuries to determine injury diagnoses, body location, type, and treatment.
—Amy X. Yin, MD
Most injuries were to the lower limbs. The knee, ankle, and foot and toes were the most common injury sites on the body, and the most common diagnoses were related to overuse: tendinitis/tendinopathy, patellofemoral pain syndrome (PFPS), apophysitis, ankle impingement syndrome, and hip labral tear.
Joints sustained 42% (n = 90) of all injuries, 31% (n = 67) affected soft tissue, and 20% were skeletal (n = 43). Physeal injuries accounted for 7% (n = 16).
PFPS was the most frequent joint injury. Yin et al noted that not only is the knee the most commonly injured joint in young athletes, but that adolescent girls—and therefore most dancers—incur anterior knee pain more often than boys.
The most common skeletal injuries seen were pars stress reaction/spondylolysis, other stress reactions/stress fractures, and nonstress fractures; physeal injuries included apophysitis and two cases of Salter-Harris (epiphyseal plate) fracture. Most soft tissue injuries were tendinitis/tendinopathy, sprain, and strain.
“Skeletally immature young dancers are vulnerable to injuries such as apophysitis and Salter-Harris fractures,” Yin said. “A lot of injuries happen in this age group because of a pattern of overuse associated with poor dance technique.”
An example is iliac crest apophysitis: “The turned-out position required for dancing promotes tight external hip rotators and abductors,” she said. “When this is combined with repetitive hip flexion, particularly in a still-growing dancer, injury becomes more likely.”
Yin noted there are few studies on dance-related physeal injuries, and she and her coauthors called for more emphasis on the needs of skeletally immature dancers because of the potential for physeal injuries to cause significant long-term disability and deformity.
“A physician with an interest in dance can help teachers and their staff become aware of biomechanical issues that can lead to injury,” she said “The multidisciplinary team approach that should be the focus of dance injury prevention may also include physical therapists, exercise scientists, dance instructors, and informed parents.”
Yin, who is now an orthopedic and sports medicine surgeon at Spherical Medicine in Oakland, CA, noted risk reduction interventions might include an individualized conditioning program based on injury history and functional movement screening, as well as tailored programs in resistance training to correct biomechanical imbalances that can result from intense training during the growing period. She also suggested tapering dance intensity before performances to help prevent injuries from overtraining.
Reed Estes, MD, assistant professor in the Department of Orthopedic Surgery at the University of Alabama at Birmingham (UAB), said, “The study is well done, and I agree the majority of the injuries are related to overuse and are therefore preventable.” Estes is chief of UAB Sports Medicine and director of its Dance Medicine Clinic. His training included work with the Boston Ballet and other dancers and athletes.
Estes pointed out that the tertiary nature of the sports medicine clinic involved in the study might have skewed results, as many patients would have sought treatment elsewhere for minor injuries or already attempted conservative management. “Also, the frequency of surgeries performed [29.8% of the sample underwent surgery] may be slightly higher because conservative management had already been attempted,” he said.
“Many dancers don’t feel comfortable with a healthcare provider who doesn’t understand the extreme demands they are under,” he said. “It’s crucial that practitioners for this age group have experience and knowledge in dance medicine. The prevalence of young dancer injuries shows the need for knowledgeable practitioners, as well as education about how to prevent and identify injuries.”
Hank Black is a medical writer based in Birmingham, AL.
Yin AX, Sugimoto D, Martin DJ, Stracciolini A. Pediatric dance injuries: a cross-sectional epidemiological study. PMR 2015 Aug 28. [Epub ahead of print]