The prevalence and impact of low back pain in pre-professional and professional dancers: A prospective study

Highlights

• Prevalence of LBP in dancers is similar to those reported in other elite sport.

• A high degree of variation exists between LBP experience and impact on participation.

• Past history of LBP increases future risk.

Abstract

Objectives

To determine the prevalence of low back pain (LBP) in pre-professional and professional dancers and its impact on dance participation, care-seeking and medication use.

Design

Prospective cohort study.

Setting

One pre-professional ballet school, two pre-professional university dance programs, and a professional ballet company.

Participants

Male and female classical ballet and contemporary dancers.

Main outcome measures

An initial questionnaire collected demographic and LBP history data. The monthly prevalence of LBP (all episodes, activity limiting episodes and chronic LBP) and impact (activity limitation, care-seeking, and medication use) was collected over a nine-month period.

Results

119 dancers participated, which represented 54% of those invited. Activity limiting LBP was reported by 52% of dancers, while chronic LBP was reported by 24%. Seventeen percent of all episodes of LBP resulted in some form of dance activity being completely missed. One-third of the sample reported care-seeking and one-fifth of the sample used medication. A history of LBP was associated with activity limiting LBP (p < 0.01; adjusted odds ratio: 3.98; 95% confidence interval: 1.44, 11.00).

Conclusions

LBP in dancers was common and had multiple impacts. This study reinforces the need for dancer access to healthcare professionals with expertise in evidence-based LBP prevention and management.

Introduction

Low back pain (LBP) is the leading cause of disability worldwide and represents significant personal and social cost (Maher, Underwood, & Buchbinder, 2017). It is often first experienced in childhood, with lifetime prevalence reaching adult levels by late adolescence (Calvo-Munoz, Gomez-Conesa, & Sanchez-Meca, 2013). Dance, which is a rigorous physical pursuit that boasts the highest participant rate for all cultural, sporting and leisure activities amongst Australian girls and the second highest for Australian male and female children combined (ABS, 2012), has been associated with a high prevalence of LBP (Crookshanks and Trotter, 1999, McMeeken et al., 2001, Swain et al., 2017). There is a strong rationale underlying this correlation. For instance, epidemiological evidence shows that engaging in work with high physical demands is a risk factor for the initial onset of LBP (Ferguson & Marras, 1997), while specific spine movements such as repetitive bending and twisting, which are integral to dance, are associated with increased reports of LBP as well as functional loss and spine injury (Ferguson and Marras, 1997, Marras et al., 2010).

Accordingly, epidemiological studies of dance injuries have identified the low back as the third most common site of injury in both pre-professional and professional classical ballet dancers (Allen et al., 2012, Ekegren et al., 2014), and the second most common site of chronic injury in Australian professional dancers (Crookshanks & Trotter, 1999). In adolescent ballet dancers, aged between 9 and 20, LBP history has been associated with future musculoskeletal injury (Gamboa, Roberts, Maring, & Fergus, 2008). Two previous LBP studies in dancers, both cross-sectional in design, have observed higher rates of LBP in dancers than controls (McMeeken et al., 2001), as well as lifetime and point prevalence rates surpassing those seen in global adolescent and adult populations (Swain et al., 2017). These findings endorse LBP as a common health issue in young, as well as professional dancers and, being well above that of the general population, warranting more attention.

Importantly, there is considerable variability in how LBP manifests in individuals (Menezes Costa et al., 2012), and simple measures of prevalence can only provide a partial overview of the problem. Little is currently known about the impact of LBP on dancers, as previous studies have focussed on how much LBP is experienced, rather than the extent to which it disrupts dance practice, or incites care-seeking and medication use. In addition, little is known about the factors associated with LBP in dance, which limits the capacity to develop targeted prevention strategies. This study had three aims: 1) to investigate, via prospective cohort design, the prevalence of LBP in pre-professional and professional dancers, 2) to determine the impact of LBP on dance participation, care-seeking and medication use, and 3) to determine factors associated with the experience of LBP.