Survey of Musculoskeletal Disorders Among Indian Dancers in Mumbai and Mangalore
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Survey of Musculoskeletal Disorders Among Indian Dancers in Mumbai and Mangalore Shruti Prabhakaran Nair, MPTh, Shruti Kotian, BPTh, Claire Hiller, PhD, MAppSc, BAppSc, and Rajani Mullerpatan, PhD, MScPT Abstract different dance forms. For both current of dramatic or expressive acting, or 1 Classical Indian dance has earned rec- pain and past injury, dancers reported abhinaya. ognition across the globe; however, the back (42.5%) followed by the knee Bharatanatyam is one of the most the health of dancers who are carrying (28.3%) and ankle (18.6%) as the most sublime and ancient of Indian classi- forth this heritage has not received due common sites. Stress was the most com- cal dances; it originated in Tanjore, monly perceived cause of injury (34.4%), attention. Therefore, this study aimed a town of Tamil Nadu in Southern to explore musculoskeletal pain and followed by over work (24.7%), tiredness 1 (17.2%), and falls (13.5%). Warm-up ex- India. This dance form lays its foun- injury prevailing among Indian dancers dation on the aesthetic beauty of in Mumbai and Mangalore. A second- ercises were always performed by 43.30% of dancers, whereas only 20% performed angles and lines formed by various ary aim was to compare pain tolerance 2 levels between dancers and non-dancers. stretching after dance. Almost 60% of positions of different body parts. Fifty-one dancers trained in different dancers participated in forms of exercise Bharatanatyam is distinguished by its traditional Indian and Western dance other than dance, e.g., swimming, yoga, grace and style, it includes traditional forms and 164 recreational dancers were and aerobics. Pain sensitivity was not sig- poses, rhythmic foot stamping, jumps, recruited as participants. An indigenous nificantly different between dancers and pirouettes, and positions where the questionnaire was designed and validated non-dancers (p = 0.159). Level of training knees are in contact with the floor. by physical therapists across various lev- and gender did not influence pain. Another dance form, Kathak, is a els of experience and dancers across partially narrative form character- various training levels. The question- ndian traditional dance encom- ized by fast foot work (tatkar), spins naire recorded dance, pain, and injury passes various indigenous dance (chakkar), and innovative use of bhav profiles. Additionally, pain tolerance was styles across India that originate (expression) in abhinaya.1,3 Odissi, evaluated using the Pain Sensitivity Ques- Ifrom temple dancing. They are catego- tionnaire among dancers and healthy a temple dance tradition from the rized into seven major kinds, namely Orissa state of India, is characterized age- and gender-matched controls (N = Bharatnatyam, Kathak, Manipuri, 200). Descriptive statistical analysis was by movement of the hips. This dance Kathakali, Odissi, Kuchupudi, and form includes variations of sitting, performed to present results of the site of Mohiniattam.1 All Indian classical current pain, site of past injury, perceived walking, leaping, and elevations that causes of injury, and exercise routine. The dances are rooted in Natyashastras reinforce some of the basic therapeutic Student’s t-test was used to compare Pain (Indian treatise on performing arts) movements of the dance.1 Kuchipudi Sensitivity Questionnaire scores between in varying proportions and, there- embraces quick movements with rapid dancers and non-dancers, and inde- fore, share common features such as footwork and sharp turns requiring pendent one-way ANOVA was used to mudras (gestures made with hands or good balance. The therapeutic effect compare scores among dancers practicing fingers), body positions, and inclusion of this dance form is embedded in its grace and fluid movements.1 Shruti Prabhakaran Nair, MPTh, Shruti Kotian, BPTh, and Rajani Mullerpatan, Indian classical dance is considered PhD, MScPT, MGM Institute’s University Department of Physiotherapy, a high form of art and was practiced MGMIHS, Navi Mumbai Maharashtra, India. Claire Hiller, PhD, MAppSc, BAppSc, Faculty of Health Sciences, University of Sydney, Sydney, Australia. in courts, temples, and on special occasions, while folk dance forms Correspondence: Shruti Prabhakaran Nair, MPTh, MGM Institute’s University are practiced in groups in rural areas Department of Physiotherapy, Sector-1, Plot No.1 & 2, Navi Mumbai - 410209, as an expression of their daily work Maharashtra, India; [email protected]. and rituals. Many folk dances are Copyright © 2018 J. Michael Ryan Publishing, Inc. https://doi.org/10.12678/1089-313X.22.2.67 67 68 Volume 22, Number 2, 2018 • Journal of Dance Medicine & Science A B C D E F Figure 1 Common dance postures in Indian classical dance. A, Kurma (turtle) pose: excessive lordosis of lumbar and cervical spine with bilateral hip knee flexion and external rotation. B, Bhramari (jump) involves high impact jumping activities wherein dancers land directly on their toes. It also involves lateral flexion and rotation of the trunk along with flexion of both knees while taking off. C, Arimandi (plie): bilateral hip-knee flexion in full squat position with hip external rotation and ankle dorsiflexion. The trunk is erect. D, Tandav (dance) pose involves unilateral weightbearing on right leg along with left hip hyperxtension and passive knee flexion and ankle plantar flexion. The trunk is required to be maintained in extension and lateral rotation. E, Nritta (dance) pose: the right knee bears the entire weight in flexed position with right hip in flexion and external rotation. F, Matsya (fish) pose: the right knee is in slight flexion and bears the entire weight. The trunk is bent forward and maintained in horizontal position in line with left lower limb. This requires good balance and control. performed by ordinary people, rather control, and regular practice.1 (12.4%), and the shoulder-neck com- than professional dancers, during Despite wide practice of several tra- plex (7.5%) as the most common sites harvesting, planting, marriages, and ditional Indian dance forms, extensive of musculoskeletal pain.4 Another religious holidays.1 Some of the popu- length of training, and performance study on Bharatnatyam dancers from lar folk dances that are performed life, Indian classical dancers’ health two different dance schools also re- across villages and cities are Bhangra, problems are rarely explored. An anal- ported the knee to be the body part Garba, Lavani, and Bihu. Irrespective ysis of musculoskeletal problems in fe- most prone to injury, followed by the of type of dance form, an exercise like male Bharatnatyam dancers reported foot, ankle, hip, and shoulder.2 dance requires much confidence, body knee (48.8%), low back (24%), ankle In addition to classical Indian Journal of Dance Medicine & Science • Volume 22, Number 2, 2018 69 dance, many Indians are now exposed as sport athletes to injury.2 Therefore, folk dance. The Western group exclu- to a variety of Western dance forms. the present study aimed to explore sively trained in international dance The most common dance forms prac- musculoskeletal disorders (pain and forms like hip hop, contemporary, ticed in Western countries include: injury) in Indian dancers, dancers’ salsa, free style, jazz, ballet, and so ballet, modern, tap, theatrical, folk, perception of the causes of injury, forth. The Mixed group practiced or flamenco, break-dancing, ballroom and their exercise routine. Lack of performed both Indian classical and dancing, and ice dancing.5-11 In the research, particularly in Indian clas- Western dance forms. United States, many surveys of the sical dancers’ health, acts as a barrier A questionnaire was designed to incidence and nature of injuries sus- to providing scientific recommenda- explore dance type, pain, and in- tained by ballet dancers have reported tions to prevent injuries and offer jury profiles, along with demographic pain in the lower extremity as the most appropriate treatment. A secondary data to provide a brief overview of common problem, followed by inju- aim of this study was to compare pain a dancer’s career. The questionnaire ries associated with the knee, ankle, tolerance levels between dancers and included: medical history, dance foot, and lower spine.5-7 A 5-year non-dancers. form or style, length of dance career, analysis at the Alvin Ailey American duration of dance training, presence Dance Center identified 58% of all Methods of supervised training, inclusion of dancers’ injuries as occurring in the After the study had received in- warm-up and cool-down exercises lower extremity, with 34% at the foot stitutional ethical clearance, 215 as a part of routine training, site of and ankle and 17% in the low back dancers across different age groups, present pain, past history of injury, and pelvis.8 Consistent with research dance forms, and training levels from and perceived causes of injuries. Pain findings in the United States, the dance institutes and academies were was defined as any pain present at back and lower limb were shown to recruited. Informed written consent the time of filling out the question- be particularly vulnerable to injury in was obtained from all participants. naire. Injury was defined as any past 141 dancers from seven professional The majority of dancers belonged to injury that caused dancers to miss a ballet and modern dance companies four well known dance institutes from dance class, rehearsal, or performance. in the United Kingdom.9 Mumbai and Mangalore (southern Content validity of the questionnaire Western Dancers reportedly have part of India). Almost one-third of was established with the assistance of a 90% lifetime injury incidence the dancers were university under- a panel of experts comprised of senior rate,11 with approximately 70% of all graduate physical therapy students physical therapy faculty members and dance-related injuries involving the who were trained in dance or who experienced dance instructors. All par- lower extremity.12 The best available performed dance as a recreational ticipants completed the questionnaire evidence suggests that musculoskel- activity.