It is well documented that there is high prevalence of injuries in pre-professional and professional ballet dancers. Current evidence from high in quality and quantity research on injury prevention in sport indicates that interventions can reduce injury risks by 30% to 50%. Injury prevention research in dance is limited. The aim of this study was to assess the feasibility (adherence, fidelity, and practicality) of a randomized controlled trial for the utilization of neuromuscular training in pre-professional ballet dancers.
Methods
A convenience sample of 22 pre-professional ballet dancers were randomized into an intervention and control group. The intervention group took part in a neuromuscular-based training workout, five times per week before the ballet class, for 10 weeks. The intervention was an adaptation of the FIFA 11+, an injury prevention intervention and is called 11+ Dance. The intervention consisted of low intensity bodyweight exercises that lasted 20 to 30 minutes performed daily.
Results
Intervention adherence was 38% ± 8%, with higher participation at the beginning of the study. Attendance for post-testing was low 45% and 36% for the intervention and control group, respectively, mainly due to injury. There were no adverse effects reported, however, the participants reported delayed onset muscle soreness at the beginning of the intervention, indicating that there may be a potential training effect. Fear of muscle hypertrophy and fatigue were also reported as reasons for attrition. The repeated measures ANOVA revealed statistically non-significant differences for the countermovement jump F(1, 9) = 0.36, p = 0.564, η2p = 0.04; reactive strength index F(1, 7) = 0.02, p = 0.885, η2p = 0.003; and the isometric mid-thigh pull F(1, 12) = 0.002, p = 0.967, η2p =0.000.
Conclusion
The results of the study, together with the feedback from the participants, suggest that some protocol modifications are necessary for the feasibility of a randomized controlled trial in a pre-professional setting. The current trial has produced valuable information for the intervention fequency and load prescription.
Get full access to this article
View all access options for this article.
References
1.
CaineDG, GoodwinBJ, CaineC, BergeronG.Epidemiological review of injury in pre-professional ballet dancers.J Dance Med Sci.2015;19(4):140–8.
2.
JacobsCL, HincapiéCA, CassidyJD.Musculoskeletal injuries and pain in dancers: a systematic review update.J Dance Med Sci.2012;16(2):74–84.
3.
SmithPJ, GerrieBJ, VarnerKE, . Incidence and prevalence of musculoskeletal injury in ballet: a systematic review.Orthop J Sports Med.2015;3(7):2325967115592621.
4.
MattiussiAM, ShawJW, WilliamsS, . Injury epidemiology in professional ballet: a five-season prospective study of 1596 medical attention injuries and 543 time-loss injuries.Br J Sports Med.2021:55(15):843–50.
5.
EkegrenCL, QuestedR, BrodrickA.Injuries in pre-professional ballet dancers: incidence, characteristics and consequences.J Sci Med Sport. 20l4;17(3):271–5.
6.
AlenN, NevillA, BrooksJ, . Ballet injuries: injury incidence and severity over 1 year.J Orthop Sports Phys Ther.2012;42(9):781–90.
7.
GamboaJM, RobertsLA, MaringJ, FergusA.Injury patterns in elite preprofessional ballet dancers and the utility of screening programs to identify risk characteristics.J Orthop Sports Phys Ther.2008;38(3):126–36.
8.
NilssonC, LeandersonJ, WykmanA, StrenderLE.The injury panorama in a Swedish professional ballet company.Knee Surg Sports Traumatol Arthrosc.2001;9(4):242–6.
9.
LeandersonC, LeandersonJ, WykmanA, . Musculoskeletal injuries in young ballet dancers.Knee Surg Sports Traumatol Arthrosc.2011;19(9):1531–5.
AmariR, SakaiT, KatohS, . Fresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: case report and literature review.Arch Orthop Trauma Surg.2009;129(3):397–401.
12.
AbelMS.Jogger's fracture and other stress fractures of the lumbo-sacral spine.Skeletal Radiol.1985;13(3):221–7.
13.
DiFioriPJ, BenjaminHJ, BrennerJS, . Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine.Br J Sports Med.20l4;48(4):287–8.
14.
LundonK, MelcherL, BrayK.Stress fractures in ballet: a twenty-five year review.J Dance Med Sci.1999;3(3):101–7.
15.
BronnerS, McBrideC, GillA.Musculoskeletal injuries in professional modern dancers: a prospective cohort study of 15 years.J Sports Sci.2018:36(16):1880–8.
16.
SoomroN, SandersR, HackettD, . The efficacy of injury prevention programs in adolescent team sports: a meta-analysis.Am J Sports Med.2016;44(9):24l5–24.
17.
EmeryCA, RoseMS, McAllisterJRMeeuwisseWH.A prevention strategy to reduce the incidence of injury in high school basketball: a cluster randomized controlled trial.Clin J Sport Med.2007;17(1):17–24.
18.
EmeryC, MeeuwisseWThe effectiveness of a neuromuscular prevention strategy to reduce injuries in youth soccer: a cluster-randomized controlled trial.Br J Sports Med.2010;44(8):555–62.
19.
OlsenOE, MyklebustG, EngebretsenL, . Exercises to prevent lower limb injuries in youth sports: cluster randomized controlled trial.Br J Sports Med.2005;330(7489):449.
20.
RösslerR, DonathL, VerhagenE, . Exercise-based injury prevention in child and adolescent sport: a systematic review and meta-analysis.Sports Med.20l4;44(12):1733–48.
21.
ReisI, RebeloA, KrustrupP, BritoJ.Performance enhancement effects of Federation Internationale de Football Association's “The 11+” injury prevention training program in youth futsal players.Clin J Sport Med.2013;23(4):318–20.
22.
RösslerR, DonathL, BizziniM, FaudeO.A new injury prevention programme for children's football—FIFA 11+ Kids—can improve motor performance: a cluster-randomized controlled trial.J Sports Sci.2016;34(6):549–56.
23.
MistiaenW, RousselNA, VissersD, . Effects of aerobic endurance, muscle strength, and motor control exercise on physical fitness and musculoskeletal injury rate in preprofessional dancers: an uncontrolled trial.J Manipulative Physiol Ther.2012;35(5):381–9.
24.
RousselNA, VissersD, KuppensK, . Effect of a physical conditioning versus health promotion intervention in dancers: a randomized controlled trial.Man Ther.20l4;19(6):562–8.
25.
AlenN, NevillAM, BrooksJH, . The effect of a comprehensive injury audit program on injury incidence in ballet: a 3-year prospective study.Clin J Sport Med.2013;23(5):373–8.
26.
EmeryCA.Injury prevention in paediatric sport-related injuries: a scientific approach.Br J Sports Med.2010;44(1):64–9.
27.
FriedmanLM, FurbergC, DeMetsDL, . Fundamentais of Clinical Trials.Heidelberg: Springer, 2010.
28.
EldridgeSM, LancasterGA, CampbellMJ, . Defining feasibility and pilot studies in preparation for randomized controlled trials: development of a conceptual framework.PLoS One.2016;ll(3):e0150205.
29.
CollinsLM, MurphySA, StrecherV.The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions.Am J Prev Med.2007;32(5 Suppl):S112–8.
30.
KeysA, FidanzaF, KarvonenMJ, . Indices of relative weight and obesity.J Chronic Dis.1972;25(6):329–43.
31.
FlanaganEP, EbbenWP, JensenRL.Reliability of the reactive strength index and time to stabilization during depth jumps.J Strength Cond Res.2008;22(5):1677–82.
32.
CloakR, NevillA, SmithJ, WyonM.The acute effects of vibration stimulus following FIFA 11+ on agility and reactive strength in collegiate soccer players.J Sport Health Sci. 20l4;3(4):293–8.
33.
GlatthornJF, GougeS, NussbaumerS, . Validity and reliability of Optojump photoelectric cells for estimating vertical jump height.J Strength Cond Res.2011;25(2):556–60.
34.
PapadopoulosK, StasinopoulosD.Reproducibility of lower strength tests using a new portable dynamometer; measurement comparisons with a non-portable dynamometer.International Journal of Physical Therapy& Rehabilitation.2016;2. Available at: www.graphyonline.com/archives/IJPTR/2016/IJPTR-112/.
35.
CastagnaC, CastelliniE.Vertical jump performance in Italian male and female national team soccer players.J Strength Cond Res.2013;27(4):1156–61.
36.
McClymontD.Use of the reactive strength index (RSI) as an indicator of plyometric training conditions.Science and Football V: The proceedings of the fifth World Congress on Sports Science and Football.Lisbon, Portugal, 2003, pp. 408–416.
37.
DiStefanoLJ, PaduaDA, BlackburnJT, . Integrated injury prevention program improves balance and vertical jump height in children.J Strength Cond Res.2010;24(2):332–42.
38.
AyalaF, Pomares-NogueraC, Robles-PalazónFJ, . Training effects of the FIFA 11+ and Harmoknee on several neuromuscular parameters of physical performance measures.Int J Sports Med.2017;38(4):278–89.
39.
Pickering RodriguezEC, WatsfordML, BowerRG, MurphyAJ.The relationship between lower body stiffness and injury incidence in female netballers.Sports Biomech.2017:16(3):1–13.
40.
LeesA, VanrenterghemJ, De ClercqD.Understanding how an arm swing enhances performance in the vertical jump.J Biomech.2004;37(12):1929–40.
41.
HaraM, ShibayamaA, TakeshitaD, FukashiroS.The effect of arm swing on lower extremities in vertical jumping.J Biomech.2006;39(13):2503–11.
42.
HaraM, ShibayamaA, TakeshitaD, . A comparison of the mechanical effect of arm swing and countermovement on the lower extremities in vertical jumping.Hum Mov Sci.2008;27(4):636–48.
43.
BishopC, ReadP, McCubbineJ, TurnerA.Vertical and horizontal asymmetries are related to slower sprinting and jump performance in elite youth female soccer players.J Strength Cond Res.2021;35(1):56–63.
44.
ChaouachiM, GranacherU, MakhloufI, . Within session sequence of balance and plyometric exercises does not affect training adaptations with youth soccer athletes.J Sports Sci Med.2017;16(1):125–36.
45.
EarlJE, MonteiroSK, SnyderKRDifferences in lower extremity kinematics between a bilateral drop-vertical jump and a single-leg step-down.J Orthop Sports Phys Ther.2007;37(5):245–52.
46.
HealyR, KennyIC, HarrisonAJ.Reactive strength index: a poor indicator of reactive strength?Int J Sport Physiol Perform.2018;13(6):802–9.
47.
WangR, HoffmanJR, TanigawaS, . Isometric mid-thigh pull correlates with strength, sprint, and agility performance in collegiate rugby union players.J Strength Cond Res.2016;30(11):3051–6.
48.
KolokythasN, MetsiosGS, GallowaySM, . 11+ Dance: a neuromuscular injury prevention exercise program for dancers.Strength Cond J.2021 Nov 10.
49.
PetushekEJ, SugimotoD, StoolmillerM, . Evidence-based best-practice guidelines for preventing anterior cruciate ligament injuries in young female athletes: a systematic review and meta-analysis.Am J Sports Med.2019;47(7):1744–53.
50.
AndersonL, Triplett-McbrideT, FosterC, . Impact of training patterns on incidence of illness and injury during a women's collegiate basketball season.J Strength Cond Res.2003;17(4):734–8.
51.
BeaudouinF, RösslerR, Aus der FüntenK, . Effects of the ‘11 + Kids’ injury prevention programme on severe injuries in children's football: a secondary analysis of data from a multicentre cluster-randomized controlled trial.Br J Sports Med.2019;53(22):14l8–23.
52.
RhodesRE, WarburtonDERBredinSSD.Predicting the effect of interactive video bikes on exercise adherence: an efficacy trial.Psychol Health Med.2009;14(6):631–40.
53.
ZdepSM, IrvineSH.A reverse Hawthorne effect in educational evaluation.Journal of School Psychology.1970;8(2):89–95.
54.
PyneDB.Exercise-induced muscle damage and inflammation: a review.Aust J Sci Med Sport.1994;26(3-4):49–58.
55.
ClarksonPM, HubalMJ.Exercise-induced muscle damage in humans.Am J Phys Med Rehabil.2002;81(11 Suppl):S52–69.
ConnollyDA, SayersSP, McHughMP.Treatment and prevention of delayed onset muscle soreness.J Strength Cond Res.2003; 17(1):197–208.
58.
KoutedakisY, JamurtasA.The dancer as a performing athlete: physiological considerations.Sports Med.2004;34(10):651–61.
59.
PolitDF, BeckCT.Essentials of Nursing Research: Appraising Evidence for Nursing Practice. Philadelphia: Lippincott Williams & Wilkins, 2009.
60.
GaldasP.Revisiting bias in qualitative research: reflections on its relationship with funding and impact.Int J Qual Methods.2017;16(1):1609406917748992.
