The prevalence and impact of low back pain in pre-professional and professional dancers: A prospective study
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.
Section snippets
Methods
A prospective cohort study was conducted over a nine-month period. Classical ballet dancers from a pre-professional ballet school (n = 95, aged 11–18), and a professional nationally touring ballet company (n = 29, age range unavailable) as well as contemporary dancers from two pre-professional university dance programmes (n = 77 and n = 19, aged 17–25) were invited to participate. Acceptance into each cohort is via an audition process, ensuring a threshold of ability. Volunteers were eligible
Results
Out of 220 individuals invited, 168 agreed to participate. The email addresses of three individuals were invalid, necessitating their exclusion from the study. Two individuals completed only the initial questionnaire and were excluded from the final analysis. The initial questionnaire as well as at least one subsequent monthly questionnaire was returned by 119 participants (54% of the sample invited, n = 100 females). Participant demographic data is presented in Table 1. Five hundred and
Discussion
The purpose of this study was to determine the prevalence and impact of LBP in pre-professional and professional dancers. In this cohort, LBP was common. The proportion of dancers that experienced an episode of activity limiting LBP (52%) during the nine month study period was above the yearly prevalence observed in the global adolescent (34%)(Calvo-Munoz et al., 2013) and adult populations (38%) (Hoy et al., 2012), and within the yearly prevalence ranges observed in a systematic review of
Conclusion
Results from this study support the assertion that pre-professional and professional dancers are vulnerable to experiencing LBP and there is suggestion of a seasonal effect in this population. Low back pain history increases future risk, and for a significant portion of dancers, pain is ongoing, interferes with dance participation and provokes care-seeking and medication use. Accordingly, dance students and professionals need access to healthcare professionals with expertise in the management
Ethics statement
The authors confirm that the participants rights and confidentiality have been well protected in all aspects and they consented to the study described in the work. All relevant ethical safeguards have been met in relation to participant protection. Approval from the appropriate ethics committees have been obtained as indicated in the manuscript.
Conflicts of interest
None.
Acknowledgments
The authors sincerely thank each dancer that took part in this study. We would also like to thank the Department of Education and Training, Victoria, as well as the teaching and health staff from each participating cohort. Additional thanks are directed to Bruce Cornell and Jan Gildea for providing comments on the manuscript.
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