Hypermobility in dancers

NewsBot · Nov 25, 2012

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Hypermobility and Joint Hypermobility Syndrome and Injury in Contemporary Dance Students
Ruemper, Alia; Watkins, Katherine
Journal of Dance Medicine & Science, Volume 16, Number 4, December 2012 , pp. 161-166(6)

The first objective of this study was to ascertain the prevalence of general joint hypermobility (GJH) and joint hypermobility syndrome (JHS) in BA Dance Theatre 1st and 3rd year students at a contemporary dance conservatory. The second objective was to determine the statistical correlation between GJH, JHS, and injury in this population. A total of 85 (female, N = 78; male, N = 7) contemporary dance students participated in the study. The Beighton score (with a forward flexion test modification) was used to determine GJH, and the Brighton criteria were used to verify JHS. Participants completed a self-reported injury questionnaire that included type of injury (physical complaint, medical diagnosis, or time-loss) and injury frequency. Statistical analysis (Pearson correlation) was used to correlate GJH, JHS, and frequency-of-injury scores. Overall, 69% of the students were found to have GJH, and 33% had JHS. A statistical correlation of r = + 0.331 (p < 0.01) was found between JHS and injury. No significant correlation was found between GJH and injury. This is the first study to look at these correlations in contemporary dance students and suggests that screening programs should include the Brighton criteria to identify JHS in these dancers. Subsequent injury tracking and injury prevention programs would then provide data for further research in this area.
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Admin2 · Nov 25, 2012

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NewsBot · May 26, 2016

Joint Hypermobility and Joint Range of Motion in Young Dancers.
Steinberg N et al
J Clin Rheumatol. 2016 Jun;22(4):171-178.

BACKGROUND:
Joint range of motion (ROM) refers to the extent of movement of the joint, recorded using standard goniometers. Joint hypermobility (JHM) is a condition in which most of the synovial joints move beyond the "normal" limits. Joint hypermobility is recognized as a feature of heritable disorders of the connective tissue and can be identified mostly by the Beighton scale. Data on the possible relationship between JHM and joint ROM are lacking in the literature. The main objective of the present study was to evaluate the relationship between JHM and joint ROM in the different lower-extremity joints in young dancers.
METHODS:
Joint hypermobility and ROM were assessed among 240 female dancers, aged 8 to 16 years, and 226 nondancers of similar age.
RESULTS:
The prevalence of JHM is significantly higher among dancers compared with the control subjects (P < 0.001). Joints' ROM is higher among dancers with JHM compared with dancers without JHM (P < 0.05). This phenomenon, however, is age dependent; as in young dancers (aged 8-10 years), this pertains only to the ankle dorsiflexion ROM. In adolescent dancers (aged 11-13 years), this relationship has been observed in most joints: ankle/foot en pointe, ankle dorsiflexion, hip external rotation, hip abduction, and hip extension. In mature dancers (aged 14-16 years), dancers with JHM had greater ROM in ankle/foot en pointe, hip abduction, and knee flexion (P < 0.05).
CONCLUSIONS:
(1) Joint ROM and JHM are associated one with the other; (2) the relationship between joint ROM and JHM is age dependent; and (3) JHM is common among young nonprofessional dancers compared with control subjects. The main clinical implications of the current study are to try and reduce the risk of injuries among JHM dancers by developing proprioceptive trainings to improve the correct alignment of the hyperextended joints, to increase their muscle strength for better stabilization of the hypermobile joints, and to provide them additional balancing and stabilizing exercises for their supporting muscles.
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NewsBot · Sep 5, 2017

Physical and Psychosocial Characteristics of Current Child Dancers and Nondancers With Systemic Joint Hypermobility: A Descriptive Analysis
Leslie L. Nicholson et al
J Orthop Sports Phys Ther, Epub 4 Sep 2017. doi:10.2519/jospt.2017.7331

Study Design
Cross-sectional study.

Background
The effect of current participation in dance training on joint pain and instability, fatigue, and quality of life is unknown.

Objectives
To examine differences in joint pain, instability, gross-motor skills, non-musculoskeletal systemic manifestations, health-related quality of life (HRQoL), and fatigue between children with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobility Type (JHS/EDS-HT) who currently undertake formal dance training and those who do not.

Methods
Children with JHS/EDS-HT and 1 parent completed reports providing data on demographic variables, symptoms, organised activity participation, HRQoL, and fatigue. Physical and functional measures included extent of hypermobility, aerobic fitness, balance, and muscle endurance.

Results
Of the 102 participating children, 22 currently undertook dance classes averaging 3.3 hours/week. While the dancers reported a similar number of painful joints as non-dancers (mean +/- SD: 5.5 +/- 3.7 versus 6.4 +/- 3.9 joints, respectively, P=.36), they reported significantly lower pain levels (3.8 +/- 3.3 versus 5.6 +/- 3.4 on a 0-10 point scale, P=.04), and found pain less problematic, affecting less of their body. They reported fewer unstable joints (1.0 +/- 1.0 versus 2.0 +/- 1.8 joints, P=.001) despite being more hypermobile (Beighton score, 7.3 +/- 1.4 versus 6.6 +/- 1.6 on a 9-point scale, P=.047; Lower Limb Assessment Score, 9.2 +/- 2.0 versus 8.1 +/- 1.9 on a 12-point scale, P=.02). The dancers had significantly better HRQoL particularly in the subdomain of school functioning (P=.004) and reported less fatigue (P=.024).

Conclusion
Children with JHS/EDS-HT who are currently undertaking formal dance training have less joint pain and instability symptoms, less fatigue, and better HRQoL, however the cross-sectional nature of the study means that causation cannot be determined.
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NewsBot · Sep 9, 2017

Physical and Psychosocial Characteristics of Current Child Dancers and Nondancers With Systemic Joint Hypermobility: A Descriptive Analysis
Leslie L. Nicholson et al
J Orthop Sports Phys Ther, Epub 4 Sep 2017. doi:10.2519/jospt.2017.7331

Study Design
Cross-sectional study.

Background
The effect of current participation in dance training on joint pain and instability, fatigue, and quality of life is unknown.

Objectives
To examine differences in joint pain, instability, gross-motor skills, non-musculoskeletal systemic manifestations, health-related quality of life (HRQoL), and fatigue between children with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobility Type (JHS/EDS-HT) who currently undertake formal dance training and those who do not.

Methods
Children with JHS/EDS-HT and 1 parent completed reports providing data on demographic variables, symptoms, organised activity participation, HRQoL, and fatigue. Physical and functional measures included extent of hypermobility, aerobic fitness, balance, and muscle endurance.

Results
Of the 102 participating children, 22 currently undertook dance classes averaging 3.3 hours/week. While the dancers reported a similar number of painful joints as non-dancers (mean +/- SD: 5.5 +/- 3.7 versus 6.4 +/- 3.9 joints, respectively, P=.36), they reported significantly lower pain levels (3.8 +/- 3.3 versus 5.6 +/- 3.4 on a 0-10 point scale, P=.04), and found pain less problematic, affecting less of their body. They reported fewer unstable joints (1.0 +/- 1.0 versus 2.0 +/- 1.8 joints, P=.001) despite being more hypermobile (Beighton score, 7.3 +/- 1.4 versus 6.6 +/- 1.6 on a 9-point scale, P=.047; Lower Limb Assessment Score, 9.2 +/- 2.0 versus 8.1 +/- 1.9 on a 12-point scale, P=.02). The dancers had significantly better HRQoL particularly in the subdomain of school functioning (P=.004) and reported less fatigue (P=.024).

Conclusion
Children with JHS/EDS-HT who are currently undertaking formal dance training have less joint pain and instability symptoms, less fatigue, and better HRQoL, however the cross-sectional nature of the study means that causation cannot be determined.
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NewsBot · Feb 24, 2018

The prevalence of generalized and syndromic hypermobility in elite Australian dancers
Cliffton Chan' et al
Phys Ther Sport; Article in Press

Highlights
•Dancers have a high prevalence of generalized joint hypermobility (GJH).
•Professional dancers demonstrated greater hypermobility on their right leg.
•The LLAS is superior to the Beighton score in assessing GJH in dancers.
•A ≥6/9 cut-point for GJH is recommended if using the Beighton score in dancers.
•Brighton and Villefranche criteria overestimate syndromic hypermobility prevalence.
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Objectives
To determine the prevalence of Generalized Joint Hypermobility (GJH) and Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome–Hypermobility Type (JHS/EDS-HT) among dancers using established validated measures.

Design
Observational Cohort Study.

Setting
Laboratory.

Participants
85 dancers from two dance institutions.

Main Outcome Measures
GJH was determined using the Beighton score (cut-point ≥5/9) and the Lower Limb Assessment Scale (LLAS) (cut-point ≥7/12). Presence of JHS/EDS-HT was assessed using the Brighton and Villefranche criteria. Paired sample t-test was performed to compare LLAS side-to-side scores, and percentage disagreements calculated to determine differences between the two GJH and the two JHS/EDS-HT measures.

Results
72% of dancers met the Beighton cut-point for GJH, while 38% and 42% met the LLAS cut-point on the left and right respectively. The proportion of dancers identified with GJH was different when assessed using the Beighton compared to the left and right LLAS (both p < 0.001), a disagreement of 48% and 46% respectively, with Beighton classifying more participants as having GJH. The Villefranche identified more dancers with JHS/EDS-HT than the Brighton (84% vs 31%, p < 0.001), with 54% disagreement.

Conclusions
High prevalence of generalized and syndromic hypermobility was found regardless of the criteria used. A higher Beighton cut-point, e.g. ≥6/9, to identify true GJH amongst dancers maybe warranted.
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NewsBot · May 6, 2018

The association between menarche, intensity of training and passive joint ROM in young pre-professional female dancers: A longitudinal follow-up study
Steinberg Nili et al
Phys Ther Sport; Article in Press

Highlights
•Longitudinal study over 12 months of dance training.
•Aimed to determine the association between menarche, intensity of training and joint ROM improvement.
•Fifty-nine dancers aged 12.8 ± 0.5.
•Most joint ROM can be improved over 12 months of dancing around the age onset of menarche.
•Hours of practice is a factor contributing to improved hip external rotation and ankle En-pointe.
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Objectives
To determine the association between the status of menarche (yes/no), the intensity of training and the potential to improve passive joint range of motion (ROM) over a 12-month period of dance training.

Design
Prospective cohort study.

Setting
Dance studio.

Participants
Fifty-nine female dancers aged 12.8 ± 0.5.

Main outcome measures
The dancers were asked about their dance intensity and screened for anthropometric parameters and passive joint ROM in Grades 7 and 8.

Results
Along the 12 months of dance training, we found significantly increased ankle-foot en-pointe, hip abduction, and hip external rotation (ER); significantly decreased hip internal rotation (IR); and significant increased hip ER:IR ratio. In Grade 7, 26 dancers (44.1%) reached menarche (Yes menarche); in Grade 8 an additional 23 dancers (39.0%) reached menarche (No/Yes menarche); and 10 dancers (16.9%) had not reached menarche (No menarche). MANOVA (mixed models) with repeated measures to compare joint ROM between the three menarche groups (Yes; No/Yes; No), with h/week dance practice as a co-variant, showed that hip ER, ankle-foot en-pointe, and ER:IR were significantly correlated with h/week in all three menarche groups.

Conclusions
Most passive joint ROM can be improved over 12 months of dancing around the age onset of menarche. H/week of dance practice is a main factor contributing to improved hip ER, ankle-foot en-pointe and ER/IR ratio.
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NewsBot · May 21, 2019

The Beighton Score and Injury in Dancers: A Prospective Cohort Study
Ross Armstrong
Journal of Sport Rehabilitation

Context:
Joint hypermobility has a high prevalence in dancers and may be associated with injury and performance.

Objectives:
To investigate whether total Beighton score can predict injury and to determine the relationship between joint hypermobility and injury and to report injury demographics.

Design:
A prospective cohort injury study.

Setting:
University Dance Injury Clinic.

Participants:
Eighty-two dancers (62 females, 20 males).

Main outcome measures:
Joint hypermobility via the Beighton score ≥ 4 with lumbar flexion included and removed.

Results:
Sixty-one dancers were classified as hypermobile which reduced to 50 dancers with lumbar flexion removed. A significant difference existed between pooled total days injured in hypermobile dancers and non-hypermobile dancers with lumbar flexion included (p = 0.02) and removed (p = 0.03). No significant differences existed for total Beighton score between injured and non-injured groups with lumbar flexion included (p = 0.11) and removed (p = 0.13). Total Beighton score was a weak predictor of total days injured (r2 = 0.06, p = 0.51). Forty-seven injuries occurred in 34 dancers and pooled injury rate was 1.03 injuries/1000 hours. Receiver operating characteristic curve analysis demonstrated an area under the curve of 0.83 for male dancers with lumbar flexion removed which was considered diagnostic for injury.

Conclusions:
The Beighton score can be utilised to identify dancers who may develop injury. Clinicians should consider the role of lumbar flexion in total Beighton score when identifying those dancers at risk of injury. Different injury thresholds in female and male dancers may aid injury management.
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NewsBot · Nov 14, 2019

Prevalence and unique patterns of lower limb hypermobility in elite ballet dancers
KatiePhanaLeslie L.NicholsonbClaire E.HilleraClifftonChanb
Physical Therapy in Sport; 14 November 2019

Highlights
•Professional dancers exhibit greater lower limb hypermobility than pre-professional dancers most evident at the hip, subtalar and midfoot joints, with the right leg being more hypermobile than the left in both groups.
•Common lower limb hypermobility profiles were identified which may assist dance teachers and treating clinicians in implementation of preventative or management strategies, especially when hip external rotation and abduction mobility are limited.
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Objectives
Determine the prevalence of lower limb hypermobility in elite dancers and secondarily to describe the patterns of mobility.

Design
Cross sectional.

Setting
Self-report questionnaires and physical assessments were undertaken at a tertiary dance institution and a professional ballet company.

Participants
Fifty-seven pre-professional and 29 professional ballet dancers (21±4years, 64% female, mean 13.7years training) were recruited.

Main outcome measures
Lower Limb Assessment Score (LLAS) was used to assess hypermobility. Prevalence was determined by descriptive statistics, between-leg and -group comparisons were analysed using the chi-square statistic and the pattern of mobility by cluster analyses.

Results
The right leg was significantly more hypermobile than the left for the whole cohort (44% vs 40% meeting ≥7/12 for the LLAS; LLAS mean/12(SD): right:5.0(2.4) and 7.6(1.9); left:4.8(2.1) and 6.7(2.0) in pre-professionals and professionals respectively (p = 0.02)). Subtalar pronation (p < 0.001) and hip abduction/external rotation (left:p = 0.01; right:p < 0.001) were significantly more hypermobile bilaterally in professionals. Three hypermobility profiles on the left and four on the right lower limb were identified.

Conclusions
This paper presents unique lower limb hypermobility profiles identified in elite dancers.
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