Comparisons in Physical Characteristic of Professional Ballet
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COMPARISONS IN PHYSICAL CHARACTERISTIC OF PROFESSIONAL BALLET AND COLLEGIATE DANCERS by Valerie Williams Bachelor of Science, Slippery Rock University, 2005 Doctor of Physical Therapy, Slippery Rock University, 2008 Master of Science, University of Pittsburgh, 2010 Submitted to the Graduate Faculty of School of Health and Rehabilitation Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Pittsburgh 2016 UNIVERSITY OF PITTSBURGH SCHOOL OF HEALTH AND REHABILITATION SCIENCES This dissertation was presented by Valerie Williams It was defended on April 7, 2016 and approved by Christopher Connaboy, PhD, Assistant Professor, Department of Sports Medicine and Nutrition Takashi Nagai, PhD, CSCS, Assistant Professor, Department of Sports Medicine and Nutrition Bradley Nindl, PhD, FACSM, Professor, Department of Sports Medicine and Nutrition Timothy Sell, PhD, PT, Associate Professor, Department of Orthopaedic Surgery, Duke University Dissertation Advisor: Mita Lovalekar, MBBS, PhD, MPH, Assistant Professor, Department of Sports Medicine and Nutrition ii Copyright © by Valerie Williams 2016 iii COMPARISONS IN PHYSICAL CHARACTERISTICS OF PROFESSIONAL BALLET AND COLLEGIATE DANCERS Valerie Williams, PhD University of Pittsburgh, 2016 Dancers are a group of athletes with unique physical and performance characteristics. Dance medicine and science is a growing field, as researchers and clinicians see the need for information specific to this population due to high injury rates. Comprehensive information on separate types of dancers, especially collegiate dancers, is unavailable. The purpose of this study was to describe and compare characteristics of professional ballet and collegiate dancers, as well as investigate the relationships among these characteristics. The first portion of the study investigates differences in body composition, lower extremity and trunk muscular strength, dynamic postural stability, and landing kinematics of professional ballet dancers and collegiate dance majors. The second portion of the study determines the ability of strength to predict dynamic postural stability and kinematic variables that are potential risk factors for injury including, knee valgus, ankle inversion, and foot pronation. Fifty nine dancers participated in the study (30 professional ballet and 29 collegiate). Equal proportions of males and females were in each group. Dancers completed an injury history questionnaire, followed by assessments of body composition, dynamic postural stability, kinematics during a dance jump task, and isokinetic and isometric muscular strength. Results demonstrate that professional dancers are significantly stronger than collegiate dancers for most muscle groups tested. The study found no significant differences in dynamic iv postural stability, and minimal differences in kinematics. No differences were found in self- reported injury histories, except that a greater proportion of professional dancers reported injuries to the ankle, and foot and toe regions. Regression analyses revealed that gender and trunk rotation strength predicted dynamic postural stability. Gender and knee flexion strength predicted maximum knee valgus angle. Gender and knee extension strength predicted ankle inversion angle at initial contact and, gender and knee flexion strength predicted maximum inversion angle. No significant predictors of foot pronation angle were found. This study provides a comprehensive assessment of professional ballet and collegiate dancers and provides insight into the relationships among their characteristics and abilities. Further research should investigate relationships in each gender separately, as well as study additional variables that explain the relationship between strength and biomechanics. v TABLE OF CONTENTS PREFACE ................................................................................................................................. XIX 1.0 INTRODUCTION ........................................................................................................ 1 1.1 INJURY EPIDEMIOLOGY IN DANCERS ..................................................... 2 1.2 PHYSICAL AND NEUROMUSCULAR CHARACTERISTICS OF DANCERS ............................................................................................................................. 4 1.2.1 Muscular Strength ........................................................................................... 4 1.2.2 Postural Stability ............................................................................................. 6 1.2.3 Biomechanics .................................................................................................... 9 1.3 COMPARISIONS BETWEEN PROFESSIONAL AND COLLEGIATE DANCERS ........................................................................................................................... 11 1.4 DEFINITION OF THE PROBLEM ................................................................ 12 1.5 PURPOSE ........................................................................................................... 13 1.6 SPECIFIC AIMS AND HYPOTHESES ......................................................... 13 1.7 STUDY SIGNIFICANCE ................................................................................. 16 2.0 REVIEW OF LITERATURE ................................................................................... 17 2.1 BACKGROUND ON DANCE TRAINING AND PERFORMANCE .......... 17 2.1.1 Basic Dance Technique Overview ................................................................ 17 vi 2.1.2 Professional Dance ......................................................................................... 19 2.1.3 Collegiate Dance ............................................................................................ 20 2.2 INJURY EPIDEMIOLOGY IN DANCERS ................................................... 21 2.2.1 Injury Incidence ............................................................................................. 21 2.2.2 Injury Location and Type ............................................................................. 24 2.3 RISK FACTORS FOR INJURY IN DANCERS ............................................ 26 2.3.1 History of Injury ............................................................................................ 27 2.3.2 Factors Related to Fatigue, Dance Exposure, and Dance Training .......... 29 2.3.3 Metabolic Considerations ............................................................................. 33 2.4 PHYSICAL CHARACTERISTICS OF DANCERS ...................................... 35 2.4.1 Body Composition.......................................................................................... 36 2.4.2 Aerobic and Anaerobic Capacity ................................................................. 37 2.4.3 Joint Range of Motion and Muscular Flexibility ........................................ 38 2.5 NEUROMSCULAR CHARACTERISTICS OF DANCERS ........................ 40 2.5.1 Muscular Strength ......................................................................................... 40 2.5.2 Postural Stability ........................................................................................... 49 2.5.3 Biomechanics .................................................................................................. 53 2.6 METHODOLOGICAL CONSIDERATIONS ................................................ 60 2.6.1 Body Composition.......................................................................................... 60 2.6.2 Muscular Strength ......................................................................................... 63 2.6.2.1 Hand Held Dynamometry .................................................................. 63 2.6.2.2 Isokinetic Dynamometry .................................................................... 64 2.6.3 Dynamic Postural Stability ........................................................................... 65 vii 2.6.4 Biomechanics .................................................................................................. 67 3.0 METHODOLOGY ..................................................................................................... 70 3.1 EXPERIMENTAL DESIGN ............................................................................ 70 3.2 SUBJECT RECRUITMENT ............................................................................ 70 3.3 SUBJECT CHARACTERISTICS ................................................................... 71 3.3.1 Inclusion Criteria ........................................................................................... 71 3.3.2 Exclusion Criteria .......................................................................................... 71 3.4 POWER ANALYSIS ......................................................................................... 72 3.5 INSTRUMENTATION ..................................................................................... 73 3.5.1 Bod Pod Body Composition .......................................................................... 73 3.5.2 Hand Held Dynamometry ............................................................................. 73 3.5.3 Isokinetic Dynamometry ............................................................................... 74 3.5.4 Dynamic Postural stability ............................................................................ 75 3.5.5 Biomechanics .................................................................................................