Faculty Bibliography

INTRODUCTION/UNASSIGNED:There is a dearth of information about whether lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) dancers, who often experience increased psychosocial risk factors, are at increased risk of engaging in harmful behaviors compared to their heterosexual cisgender counterparts. This study explores harmful behaviors dancers engage in according to their self-reported sexual orientation and gender identity (SOGI), utilizing the validated Risky, Impulsive, and Self-Destructive Behavior Questionnaire (RISQ). METHODS/UNASSIGNED:-test were utilized to assess statistical differences among RISQ outcomes in 4 SOGI groups: Cisgender Heterosexual Female (n = 20); Cisgender Heterosexual Male (n = 7); LGBTQ+ Female (n = 19); and LGBTQ+ Male (n = 20). RESULTS/UNASSIGNED: = .006). CONCLUSIONS/UNASSIGNED:This study found significant difference in RISQ scores based on a dancer's SOGI. Harmful behaviors should be taken into consideration when working to improve dancer patient outcomes and quality of life.

BACKGROUND:The spinal biomechanics of dance tasks have received little study and no studies have used a multi-segmented spinal model. Knowledge of how the segments of the spine move may be useful to the dance clinician and dance educator. RESEARCH QUESTION/OBJECTIVE:What is the direction and amount of motion of the primary segments of the spine in elite dancers during an arabesque and a passé? METHODS:This observational study examined 59 elite dancers performing an arabesque and a passé using a three-dimensional motion analysis system with the trunk divided into a series of five segments: pelvis, lower lumbar, upper lumbar, lower thoracic and upper thoracic spine. RESULTS:For the arabesque, all spinal segments moved in the same direction within each plane and the majority of total spinal motion occurred in the thoracic spine. Thoracic segments were at or near end range position at completion of the arabesque. For the passé, the spinal segments moved in different directions within each plane and the majority of total spinal motion occurred in the lumbar spine. SIGNIFICANCE/CONCLUSIONS:Dance clinicians and dance educators may benefit from the knowledge that thoracic hypomobility in any plane may limit arabesque performance and that attempts to instruct dancers to achieve a position of passé without flexion of the lumbar spine may be a valid aesthetic ideal but also an unrealistic functional expectation.

BACKGROUND:Altered spine kinematics are a common in people with LBP. This may be especially true for populations such as dancers, who are required to perform repetitive movements of the spine, although this remains unclear. RESEARCH QUESTION/OBJECTIVE:Do dancers with recent LBP display altered spine kinematics compared to their asymptomatic counterparts? METHODS:A cross-sectional study of multi-segment spine kinematics was performed. Forty-seven pre-professional and professional female dancers either with LBP in the past two months (n = 26) or no LBP in the past 12 months (n = 21) participated. Range of motion (ROM) during standing side bending, seated rotation, and walking gait were compared. RESULTS:Female dancers with LBP displayed reduced upper lumbar transverse plane ROM in seated rotation (Effect Size (ES)= -0.61, 95% Confidence Interval (CI): -1.20, 0.02, p = 0.04), as well as reduced lower lumbar transverse plane ROM (ES=-0.65, 95% CI: -1.24, -0.06, p = 0.03) in gait. However, there was increased lower thoracic transverse plane ROM (ES = 0.62, 95% CI: 0.04, 1.21, p = 0.04) during gait. No differences in the frontal plane were observed. SIGNIFICANCE/CONCLUSIONS:Altered transverse plane spine kinematics were evident in dancers with recent LBP for select segments and tasks. This may reflect a protective movement strategy. However, as the effect sizes of observed differences were moderate, and the total number of differences between groups was small, collectively, it seems only subtle differences in spine kinematics differentiate dancers with LBP to dancers without.

Repetition of jumps in dance and sport training poses a potential injury risk, however non-contact landing injuries are more common in athletes than dancers. This study aimed to compare the lower limb stiffness characteristics of dancers and athletes during drop landings to investigate possible mechanisms of impact-related injuries. Kinematics and kinetics were recorded as 39 elite modern and ballet dancers (19 men, 20 women) and 40 college level team sport athletes (20 men, 20 women) performed single-legged drop landings from a 30-cm platform. Vertical leg stiffness and joint stiffness of the hip, knee and ankle were calculated using a spring-mass model. Stiffness data, joint kinematics and moments were compared with a group-by-sex 2-way analysis of variance. Multiple linear regression was used to assess the relative contribution of hip, knee and ankle joint stiffness to variance in overall vertical leg stiffness for dancers and athletes. Dancers had lower leg (p<0.001), knee joint (p=0.034) and ankle joint stiffness (p=0.043) than athletes. This was facilitated by lower knee joint moments (p=0.012), and greater knee (p=0.029) and ankle joint (p=0.048) range of motion in dancers. Males had higher leg (p<0.001) and ankle joint stiffness (p<0.001) than females. This occurred through lower ankle range of motion (p<0.001) and greater ankle moment (p=0.022) compared to females. Male and female dancers demonstrated reduced lower limb stiffness compared to athletes, indicating a more pliable landing technique. Dance training techniques could potentially inform approaches to injury prevention in athletes.

An injury that causes a dancer to take time away from training or performance can be career ending, and thus it is important for dancers to have accurate expectations when considering treatment options. Thus far, few studies have reported functional outcomes after injury in dancers, which may be different than for the general athletic population. Therefore, our study sought to determine functional outcomes in dancers after operative and non-operative treatment for common dance injuries. Our outcome measures included a subjective assessment of the degree to which a dancer had returned to his or her previous level of dance, the SF-12 survey, and the WHO functional outcome scale modified for dance. We also compared these as outcome measurement tools for return to full function in dance. Secondarily, we sought to assess factors that may have contributed to poorer functional outcomes. We reviewed the charts of 675 dancers seen at our physical therapy facilities between 2006 and 2010 and identified 416 adult dancers who had experienced a dance-related injury that we categorized as "common," based on surveys of injuries among dancers (with back injuries excluded). One hundred and sixty-four dancers completed a tele- phone survey about their recovery after injury. Descriptive statistics, correlation, and linear regression were then used to identify factors associated with poor functional outcomes. Sixty-three percent of the participants had a full return to their pre-injury level. No variables were found to be significantly correlated (p < 0.05) with poorer outcomes by linear re- gression. However, there was a trend to- ward better outcomes when dancers were younger, their injuries were not chronic, and their recovery was not limited by fear. The three measurement tools were all highly correlated with one another (p = 0.000) and found to be useful determinants of functional return to dance. Given that there were few strongly correlated outcome factors, we concluded that poorer functional outcomes in dance resulted from a combination of many factors, including those of a psychosocial nature. We believe these results can be used to better advise dancers who are considering treatment options, provide better estimates of possible limitations and time needed to return to dance, and potentially promote easier recoveries and better functional outcomes.

The female athlete triad/ hypothalamic amenorrhea and polycystic ovarian syndrome (PCOS) are both common causes of irregular periods in young women. A 26-year-old woman presented with right hip pain after performing for 2 months in her first Broadway show. She was diagnosed with a left inferior (compression) femoral neck stress fracture by MRI scan. Because she had no history of fracture but had irregular periods, she was sent to endocrinology for evaluation. Her menarche was at 13-years-old. She had irregular periods throughout high school and she reported missing approximately 2-3 menstrual cycles a year. She took isotretinoin (Accutane) for acne in college and reported excess body hair, but was never worked up for PCOS. She denied weight changes and any eating disorder. Her food journal revealed an average intake of 1395 kcal per day with restriction of carbohydrates. Her food intake did not increase during periods of intense activity because of not taking time to plan ahead for meals and not wanting to eat before performing. Her weight was 98 pounds with a BMI of 19.83 kg/m². Her exam showed mild hirsutism (Ferriman-Gallwey score of 12) and cystic acne. Her blood work was unremarkable except her total testosterone was 40 ng/dL (nl: 9-55) and her dehydroepiandrosterone sulfate (DHEAS) was elevated at 428 ug/dL (nl: 65-380). Her bone density revealed an AP spine Z-score of-3.0, left femoral neck Z-score of-2.6, and right femoral neck Z-score of-2.9, all consistent with low bone mass for age. Her irregular periods provided a clue for underlying hormonal dysfunction and eating patterns that resulted in her low bone mass and fracture. While she did not have an overt eating disorder with anorexia or bulimia, long term exposure to restrictive eating patterns led to poor bone health and affected her accrual of peak bone mass. Her case also highlights that biochemical and physical evidence of elevated androgen levels often seen in PCOS may occur simultaneous with the female athlete triad and these symptoms may lead to challenges in the appropriate diagnosis