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Key Findings: 2nd National Injury into Dancers’ Health and Injury

by Helen Laws

What follows are some of the key findings from Dance UK’s 2nd National Inquiry into Dancers’ Health and Injury in the UK. A comprehensive report will be available later in 2004.

The findings shared here are derived from a survey by questionnaire distributed to 3200 professional dancers and vocational dance students in the UK in 2002. The questionnaire was based on that used in the original survey, carried out in 1994, the results of which were published in Fit to Dance? Dance UK received 1056 completed questionnaires, giving a response rate of 33% (an improvement on the 658 useable responses and 19% response rate in the original inquiry).

Findings on injuries

Of the respondents, 80% had incurred at least one injury in the last 12 months, (81% of professionals, 80% of students). In the original inquiry 83% of ballet professionals, 84% of contemporary professionals and 83% of students recorded at least one injury in the last 12 months. So we are moving in the right direction but not significantly so.

Types and sites of injury

  • Ballet dancers were more likely to have any injury than other dancers (84% vs 78%).
  • Ballet dancers were also more likely to get bone (21% vs 15%), tendon (26% vs 18%), foot (23% vs 11%) and ankle (30% vs 20%) injuries.

Although it would be easy to assume that the latter two in particular may be due to pointe work, in fact a slightly higher percentage of male ballet dancer showed injuries in these areas than their female counterparts.

  • Musical Theatre dancers were more likely to have muscle (55% vs 46%), groin (19% vs 10%) and thigh (21% vs 12%) injuries.

There was a very similar distribution of injuries across the sites of the body in 1994 and 2002, with the lower back still being the most common site of injury followed by sites in the lower limbs.

  • Dancers with lower back injuries were more likely to also have shoulder (19% vs 9%), neck (22% vs 9%), upper back (17% vs 7%), pelvis (7% vs 1%), groin (21% vs 9%), hip (16%vs 7%), thigh (19% vs 12%), lower leg (20% vs 12%) and foot (22% vs 13%) injuries than those without a lower back injury.

Perceived cause of injury

When reporting perceived causes of injury dancers still cite ‘fatigue’ and ‘overwork’ as the most common perceived causes of injury along with ‘repetitive movements’. All three were cited by over 33% of all professionals. Ballet and contemporary professionals and students all cited the new category ‘recurrence of old injury’ as one of the most common causes of injury (34%, 36% and 26% respectively). Ballet professionals showed an increase citing of ‘new and difficult choreography’ (14% up to 21%) and they cited ‘rehearsal schedule’ more than those dancing in other styles (17% vs 10%).

Time off due to injury

  • Professional dancers had an average of 11.5 days off class, 7.9 days off rehearsal and 6.6 days off performance each due to injury in the last 12 months.
  • Dancers had an average of 13 days each off all three as a result of longer-term injuries.
  • 14% of dancers had experienced a longer-term injury keeping them off dancing for periods of weeks, up to 18 months.

Costs of and payment for injury

  • Dancers paid an average of £163 each for treatment for injury in the last 12 months.
  • A significantly higher percentage of professionals said their employer pays for treatment (42%) than schools pay for students’ treatment (15%).

Generally, less professional dancers are having to pay for treatment and more companies are taking on that responsibility than in 1994, showing that dancer companies realise that it is worth investing in their dancers.

Treatment of injury

As a general trend, dancers use Pilates practitioners as often as they do massage therapists in 2002, and seeking treatment from these practitioners come second only to seeing a physiotherapist.

  • 60% of dancers see a physiotherapist in the first instance when injured, making them the most popular first port of call. Osteopaths and GPs are seen significantly less in 2002 as a first port of call.
  • More ballet professionals (42% vs 17%) and ballet students (32% vs 21%) saw a Pilates professional for rehabilitation.
  • Among professional dancers more of those who did ballet saw a massage therapist for rehabilitation (63% vs 27%). This perhaps reflects the on-site facilities now available particularly within professional ballet companies.

Findings on lifestyle and psychological issues

Psychological problems are experienced more often than physical injury. The most frequently cited problem is ‘tension with people’ followed closely by ‘constant tiredness’, ‘low self-confidence’ and ‘general anxiety’ all of which over 50% of dancers say they have experience in the last 12 months.

  • Ballet professionals have experienced an increased incidence of alcohol/drugs overuse (8% up to 17%), difficulty concentrating (13% up to 23%), external stress (35% up to 49%), and performance anxiety (36% up to 48%), since 1994.
  • There has been an overall decrease in numbers of dancers claiming to have had eating problems in the last 12 months (21% down to 16%) since the 1994 survey. Significantly more students than professional dancers recorded having suffered from eating problems (19% vs 7%), low self-confidence (58% vs 40%), and constant tiredness (60% vs 43%).

When looking at injury in relation to experience of psychological problems, a significantly higher percentage of people who said they had experience such psychological problems in the last 12 months had also experience an injury in the same time frame.

There were a number of relationships between specific psychological problems and types and sites of injury that showed particularly high significance, for example:

  • Those who had experienced tension with people were more likely to have muscle injuries (54% vs 42%).
  • Those who had experienced drug/alcohol overuse were more likely to have muscle (66% vs 47%), shoulder (22% vs 10%), and neck (24% vs 12%) injuries.
  • Those who had experienced constant tiredness were more likely to have muscle (56% vs 42%), and lower back (35% vs 25% ) injuries.

There is clearly a strong relationship between psychological problems and pressures, and injury, however these results can’t confirm the direction of that relationship. More research that monitors injury rates and mood states of dancers over time is needed to establish the possible direction of these relationships.

Sleep and time off

Students have a significantly higher difference between the hours of sleep they say they need and actually get than professionals (-1.35 vs -0.82). This correlates with them also experiencing ‘constant tiredness’ more than professionals and dancers in general citing fatigue and overwork as one of the main causes of injury.

  • Dancers had an average of 1.3 days off per week. 11% of dancers said they had no days off. 44% said they had 0.5-1 day off. 44% said they had 1.5-2 days off. 1% said they had 3 days off per week on average.

Warming up and cooling down

Professional dancers appear to be more conscientious about warming up before a performance than at other times. There is still less cooling down than warming up taking place but the statistics show an increase across the board of dancers cooling down in 2002.

  • Ballet professionals appear to be less likely to cool down than other dancers.
  • People who cooled down after rehearsing were less likely to have any injury (78% vs 83%).

Smoking

  • In 1994, 36% of females and 40% of males were smokers. In 2002, 19% of females and 28% of males smoked. This appears to show that dancers are smoking less.
  • Our statistics showed that current smokers were more likely than non-smokers to have bone (24% vs 16%), neck (17% vs 12%), shoulder (16% vs 11%), lower back (38% vs 29%), groin (17% vs 12%) and hip (14% vs 9%) injuries.

Diet

  • 15% of 1994 respondents said they were on a diet whereas 23% of dancers in 2002 said they were on a weight reducing diet.
  • In 2002, 2% were on a weight gain diet, 9% were vegetarian and 14% were on another diet.

Although the percentages for different types of diet were not broken down in 1994, the figures we do have indicate that more people are dieting in 2002 than were previously. Less dancers said they had had an eating problem in the last 12 months in 2002. Does this mean dancers are dieting more responsibly now? Or are they ignoring a potential problem? 25% of respondents said they felt they had had an eating problem at some point in the past.

  • A lower percentage of professional dancers than students were on a weight reducing diet (10% vs 27%).

When asked where they took dietary advice from:

  • 14% said they took it from an accredited dietitian, 11% took it from a GP, 34% took it from company or school staff, 30% took it from friends, 40% took it from the media or literature and 14% took it from another source.

This shows how essential it is that dancers and dance staff are well educated in where to find safe, appropriate and scientifically sound nutrition information.

Women

  • 36% of female dancers said that their periods were not regular when they were not on the pill.
  • 17% of female dancers had experienced amenorrhoea (periods stopping for 6 months or more) at some point in the past. 64% of those had sought medical advice when this happened.

Originally published in Dance UK  magazine, Issue 52 – Spring 2004