Original ResearchLife history and point prevalence of low back pain in pre-professional and professional dancers
Introduction
Low back pain (LBP) is a common and potentially disabling condition that creates significant personal, social and economic loss (Buchbinder et al., 2013). Populations engaged in daily activities that require prolonged cyclic spine movements are reported to be the most vulnerable to the development of LBP (Solomonow, 2012). Furthermore, when these movements are performed with repetition, at high velocities, in multiple planes of motion, and when handling heavy loads, the risk of developing LBP increases significantly (Marras et al., 2010, Solomonow, 2012). Dance is a physically demanding pursuit that involves complex spine movements performed with high repetition, at varying velocities, and as a component of intense training programmes. Therefore, LBP is often cited as one of the most common musculoskeletal conditions among dancers. However this information is largely anecdotal, with very little data existing to demonstrate that such a relationship between dance and LBP actually exists.
A number of previous studies have demonstrated that low back injuries commonly occur in dance. Large injury surveillance studies have identified the low back as the third or fourth most common site of injury in pre-professional and professional dance (Allen et al., 2012, Gamboa et al., 2008), and self-reported data from professional dancers indicate the low back as the second most common site of chronic injury (Crookshanks, 1999). Low back injuries often result in a prolonged time away from dance. Indeed, specific lumbar injuries, such as disc injuries, facet joint dysfunction and nerve root pathologies, require the third longest time for dancers to return to full activity (Allen et al., 2012, Ekegren et al., 2014), indicating the impact on practice is significant. However, these studies have all employed injury definitions that overlook pain and thus likely underestimate the problem. There have been few attempts to quantify the prevalence of LBP in dance. Prior investigations into musculoskeletal pain reported between 70% (Ramel & Moritz, 1994) and 82% (Ramel, Moritz, & Jarnlo, 1999) of professional ballet dancers had experienced some form of low back pain in the previous 12 months. A retrospective study of dance students found that 49% of female and 59% of male dancers reported at least one prior episode of back pain during their lifetime (McMeeken et al., 2001), although the study employed broad definitions of both ‘back pain’ and ‘dancer’. A more recent study noted that 62% of ballet students reported some form of lumbosacral pain, however it was unclear what time period this represented (Drężewska & Śliwiński, 2012).
In order to help mitigate the risk of LBP in dancers, demographic or physical factors that may be associated with increased LBP need to be identified. For instance, due to traditional gender roles and subsequent lifting demands associated with ballet, it has been suggested that male dancers are particularly prone to LBP (Alderson, Hopper, Elliott, & Ackland, 2009). However, this has not yet been confirmed in epidemiological studies. Outside of dance, higher LBP prevalence has been more commonly seen in females rather than males (Hoy et al., 2012). The relationship between age and LBP risk in dance also requires further investigation. Due to early commencement of training and specialisation, many dance students are required to sustain high levels of physical exposure during periods of growth and maturation, which may further increase LBP vulnerability. Studies have shown that injury incidence in dance students increases as training progresses (Ekegren et al., 2014, Leanderson et al., 2011), and LBP risk may also increase with age (Calvo-Munoz et al., 2013, Hoy et al., 2012, Newlands et al., 2015). Confirming any such relationship would be of undoubted clinical value.
The risk of LBP in dance is perceived to be high; however there is a lack of data regarding the prevalence of LBP in dancers. The purpose of this study was to determine the lifetime and point prevalence of LBP within pre-professional and professional dance settings, using accepted definitions of LBP (Dionne et al., 2008), and to identify any demographic or physical factors associated with LBP lifetime and point prevalence.
Section snippets
Methods
Using a cross-sectional design, male and female contemporary and classical ballet dancers and dance students aged 12 years and over were recruited from a pre-professional ballet school, two pre-professional university dance programs, and a professional nationally touring ballet company. Based on curriculum outlines, weekly dance activity was estimated to begin at 13–18.5 h, for school students depending on year level, and to be around 24 h for university students. These estimations do not
Results
In total, 91 female (mean (SD) age, 17.9 (2.6) years) and 19 male (17.1 (3.7) years) dancers agreed to participate in the study, which represented 50% of the invited population. Participants had a mean (SD) BMI of 20 (2.6) and had commenced dancing at 7.9 (4.8) years of age. Descriptive data are presented in Table 1. Of the dancers who participated in this study, 73.6% (n = 81) indicated they had a history of LBP, 23.6% (n = 26) were currently experiencing LBP, while 46.4% (n = 51) and 63.6%
Discussion
The aim of this study was to determine past history as well as present status of LBP in pre-professional and professional dancers from both classical ballet and contemporary dance settings. High lifetime history (73.6%), 12 month prevalence (63.6%), and point prevalence (23.6%) were reported by dancers. The proportion of dancers who reported LBP in the past 12 months was similar to the levels previously reported in professional Swedish ballet dancers (70%) (Ramel & Moritz, 1994) but lower than
Conclusion
The prevalence of LBP in pre-professional and professional dancers is higher than commonly observed in the general and athletic populations. No differences were observed in any demographic or physical related factors, indicating the onset of initial LBP experiences may occur at a young age, and that the causes of LBP episodes are complex and not easily discerned.
Ethical statement
Ethical approval was granted by the Australian Catholic University institutional Human Research Ethics Committee (2015-313E). All participants provided written informed consent/assent, as well as parental consent when required.
Funding
None declared.
Conflicts of interest
None declared.
Acknowledgements
The authors would like to thank each dancer that took part in this study. Additional thanks are directed towards the Department of Education and Training, Victoria, and to individuals Maggie Lorraine, Tim Storey, Janet Karen, Liz Hewett, Gene Moyle, Melanie Fuller, Jenny Kinder, Anna Smith, and Jacqueline Swiatiowski for their assistance at various stages of this process.
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