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Musculoskeletal Pain in Latin American Formation Dance Localization, Assessment, and Related Behavior

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Musculoskeletal Pain in Latin American Formation Dance Localization, Assessment, and Related Behavior Musculoskeletal Pain in Latin American Formation Dance Localization, Assessment, and Related Behavior Eileen M. Wanke, MD, PhD, Jasmin Haenel, MSc, and David Alexander Groneberg, MD, PhD Abstract joint, forefoot, and toes) were significantly Rumba, Cha-Cha-Cha, PasoDoble, Competitive Latin formation dance, more affected in females than in males (p and Samba), as defined by the WDSF a form of dancesport, places extreme < 0.05). Sensory and affective pain percep- (World DanceSport Federation).1,2 In physical demands on dancers that can tion ranged from “hardly” to “moderate,” addition to dance movement patterns cause pain. Due to the sex-specific re- with female dancers being more severely that are typical of single couple dance, quirements of dancesport, sex-specific affected. Almost 80% of each sex contin- ued dancing despite pain. Intrinsic mo- a number of formation dance-specific differences in pain are probable. The and rating-relevant movement ele- aim of this study was to analyze pain tives and solidarity with the dance team were most often given as reasons for this ments (e.g., round about) associated with regard to prevalence, localization, with large and asymmetrical loads perception, assessment, and related be- behavior. Primarily, sex-specific physical havior in male and female Latin formation requirements seemed to be most relevant on the musculoskeletal system of a dancers. The quantitative cross-sectional in the occurrence of pain; in addition, dancer’s body are performed by for- observational study was carried out pain assessment characteristics and per- mation teams. Despite the movement with 41 female and 31 male dancers of sonal behavior were related to attitudes specificity in formation dance that a national premier league by use of an regarding pain and injury. Therefore, in promotes injuries (e.g., close proxim- anonymous online survey, with 3- and addition to sex, motivational and socio- ity of couples, high dynamics), studies 12-month pain intervals being recorded. cultural factors should be considered in of formation dance related injuries future studies of this subject. Of all participating subjects, 33 females remain very limited.3,4 McCabe et al.,5 and 26 males confirmed having been in in particular, suggested the need for ancesport is a competition- pain during the most recent 3 months further research in this subject. and performance-oriented and provided detailed information on Several studies have, however, con- the pain factors being studied. In order variant of ballroom dancing sidered the matter of injuries in these to operationalize pain characteristics, Dand is one of the technical and aes- dance genres, with specific emphasis existing pain assessment measures were thetic types of sport. Among other on sex differences and the role played adapted for dancers. For the most painful dancesport disciplines, there is stan- by pain. Miletic et al.6 showed sig- body regions, accompanying symptoms, dard and Latin formation dance, with nificant differences between males and pain intensity, pain perception, and pain generally eight dance couples form- evaluation were surveyed. The pain be- females in the following pain regions ing one team. The aim of the eight havior section included questions about of standard and Latin dancers: hip couples is to move in synchronization, trusted persons and dancing despite pain, (female: 10%; male: 35%, p = 0.005), precisely, and for the most part sym- as well as pain management strategies. As lower thigh (female: 6%; male: 24%, metrically on a dance floor performing to pain localization, several parts of the p = 0.016), and toes (female: 45%; the five formal Latin dances (Jive, lower extremity (hip joint, groin, ankle male: 22%, p = 0.025). With regard to injury sites in Latin Formation Dance, Eileen M. Wanke, MD, PhD, Jasmin Lampe, MSc, and David Alexander Groneberg, MD, PhD, Johann Wolfgang von Goethe University, Institute differences between males and females of Occupational, Social, and Environmental Medicine, Frankfurt am Main, are particularly evident at the thigh Germany. (female: 25%; male: 8%), knee (fe- male: 6%; male: 22%), and foot and Correspondence: Eileen M. Wanke, MD, PhD, Goethe-University Frankfurt toes (female: 28%; male: 16%).7 To Main, Institute of Occupational, Social, and Environmental Medicine, Theodor- what extent pain signals a health risk Stern-Kai 7, 60590 Frankfurt am Main, Germany; [email protected]. for dancers depends on the intensity Copyright © 2020 J. Michael Ryan Publishing, Inc. 24 https://doi.org/10.12678/1089-313X.24.1.24 Journal of Dance Medicine & Science • Volume 24, Number 1, 2020 25 of the perceived pain and how danc- The purpose and content of the Contents of the Questionnaire 8-10 ers respond to it. The stronger the survey, as well as the persons and in- Information on each participant’s pain and the more it limits dancing, stitutions responsible for the research, dance training was solicited. This the more it is perceived as a “nega- were explained to potential study par- included the main dance style per- tive” that poses a problem requiring ticipants in a letter. The chosen design formed, years of dance experience, 8,9 medical attention. Two studies in of the study (i.e., on an anonymous training hours per week, and prepara- dancesport used the Self-Estimated and voluntary basis) did not neces- tion for competitions or performanc- Functional Inability Because of Pain sitate written consent on the part of es. Demographic data such as age, (SEFIP) test to measure pain intensity the participants. The inclusion criteria height, weight, and current diseases in different body regions in relation for the study were non-professional or injuries were also queried (Table 1). 6,11 to performance capability. Dance- dancers who were at least 18 years of The pain questionnaire contained five limiting pain (levels 3 and 4) was age and participated in Latin forma- “Blocks”: 6,11 rare ; thus, only 3 out of 86 standard tion dance. In total 72 subjects (41 A. Pain prevalence, and Latin dancers had to avoid certain females, 31 males) participated in this B. Pain localization, 6 movements due to pain. Continu- study. C. Pain perception, ing to dance despite being in pain Study procedures were approved by D. Pain assessment, and is a frequently practiced behavior in the University Research Ethics Com- E. Pain-related behavior 8,12 dance. In one study of Latin For- mittee of Johann Wolfgang Goethe- Block A consisted of four items. mation Dance, 55.8% of males and University, Frankfurt, Germany. These contained questions on pain 35.4% of females ignored injuries and the resulting pain.7 Important behav- ioral motives were involved, including responsibility to the dance team and Table 1 Population and Dance Training-Related Data of Female (N = 41) performance pressure.7 and Male (N = 31) Dancers It must also be considered that the Female Male P-value dancer’s sex seems to play a role in pain perception and management as Age (years)* well as his or her attitude toward and x̅ (SD) 22.7 (4.6) 25.9 (7.2) 0.03 coping behavior for pain.13-15 Only Height (cm)† the aforementioned few studies have x̅ (SD) 167.7 (6,8) 180.7 (6.8) 0.00 investigated pain in dancesport. Lack- Weight (kg)† ing are studies that in a sophisticated x̃ (I50) 60.0 (10.0) 75.0 (15.0) 0.00 manner present various dimensions Body mass index (kg/m2)† of pain (location, perception, assess- x̃ (I50) 21.2 (3.4) 23.2 (3.6) 0.00 ment, behavior) sustained by either Diseases yes/no sex in dancesport. The aim of this M (VR) no (0.18) no (0.17) 0.89 pilot study was to begin to fill that Missing [N (%)] [2 (4.9)] [1 (3.2)] void, with concentration on Latin formation dancers. Injury yes/no M (VR) no (0.23) no (0.16) 0.47 Methods Missing [N (%)] [2 (4.9)] - Study Design and Population Years of dancing (total) The data of this quantitative obser- x̅ (SD) 9.9 (5.5) 10.1 (6.9) 0.89 vational study were generated by a Missing [N (%)] [1 (2.5)] - fully structured cross-sectional online Years of dancing (main dance style) questionnaire. The pain aspects of x̃ (I50) 5.0 (5.0) 5.0 (9.0) 0.42 the questionnaire were based on pat- Missing [N (%)] [2 (4.9)] - terns of pain perception, assessment, Hours per week and related behavior according to x̃ (I50) 6.0 (5.0) 7.0 (5.0) 0.91 Birbaumer and Schmidt,16 who used Missing [N (%)] [1 (2,4)] - a 12-month time period for general Competitions yes/no information on pain and a 3-month M (VR) yes (0.05) yes (0) 0.50 period for more detailed information. Performances yes/no* The operationalization of pain aspects M (VR) yes (0.25) yes (0.38) 0.04 was carried out by modifying existing Missing [N (%)] [3 (7.3)] [2 (6.5)] pain measuring instruments used in *p < 0.05; †p < 0.01; x̃: median; I50:interquartile range; x̅ : mean; M: mode; VR: variation 8,9,12 the dance-specific literature. ratio. 26 Volume 24, Number 1, 2020 • Journal of Dance Medicine & Science Table 2 Pain Prevalence in Latin Formation Dancers and accompanying symptoms used Female Male a four-level Likert scale from “not” N (%) N (%) P-value (1) to “very” (4). The body regions (Table 3) were chosen by the subjects 12-month prevalence from those of the SEFIP test.18 The Pain while dancing 34 (82.9) 22 (71.0) 0.34 authors of this study, however, chose Pain within 24 hours after dancing 33 (80.5) 23 (74.2) 0.90 to supplement and present selected 3-month prevalence body regions in a more differentiated Pain while dancing 32 (78.0) 24 (77.4) 0.95 way (e.g., upper and lower extremi- Pain within 24 hours after dancing 31 (75.6) 23 (74.2) 0.89 ties, head, and foot regions).
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