Fit to Dance: Dance injury in China
By Yanan Dang and Matthew Wyon
The Fit to Dance surveys carried out by Dance UK in 19951 and 20032 remain the largest surveys of dancers’ health and provided the foundation for numerous studies into injury incidence, physiological conditioning and psychological health (cited in 114 published articles and books). Although surveys do not provide a strong level of evidence compared to prospective studies, as they require participants to recall incidence over the previous 12-months (as in the case of the Fit to Dance surveys), they have much larger participant numbers and allow a snapshot, impression of the situation under scrutiny. At the University of Wolverhampton we have previously adapted to the Fit to Dance survey to gain an insight into dance genres not covered in depth in the original surveys; these have included DanceSport3, hip-hop4 and bellydance.
The Fit to Dance II dancer survey was translated into Chinese and after a pilot study to check the accuracy of the translation, distributed via social media which closed in June 2018 with 1040 completed surveys. The majority of respondents were students (n=871, 83.8%) and female (n=861, 82.8%). Similar to the UK, student participants of the survey were either in full-time training at vocational schools (~11 years old, 36.5%) or as undergraduate students (~18 years old, 34%). The professional dancer respondents mainly had 8-12 month contracts (79.9%) and had been a professional dancer for less than 3 years (47.4%). Chinese folk dance was reported to be the main dance genre (n=462, 44.4%), followed by Chinese traditional dance (n=266, 25.6%), ballet n=106, 10.2%) and contemporary (n=102, 9.8%) (fig 1).
We have divided the survey results into convenient areas for commentary, though recognising this analysis is researcher-led and the reality is more complex.
General health and diet
Interestingly, 87% didn’t smoke and 71% reported not drinking alcohol (18 yr old+). Fifty-seven percent (n=593) of the respondents reported following a weight reducing eating plan getting their advice from media/literature (45.6%) and friends (31.1%). A further 21.4% reported a current eating disorder, whilst 26.7% said they had psychological issues with eating. Those that took nutritional supplementation (34.7%), mainly took multivitamins (67.9%) and/or calcium (43.7%).
Fifty-four percent thought they should get 8 hours sleep a night but only 19% reported achieving this. The majority of student and professional dancers got 6-7 hours a night, with 10.3% and 12.4% reporting getting less than 6 hours, respectively. Both groups reported getting 1 (students 38%, professionals 45%) or 2 (students 51%, professionals 44%) days of rest a week.
The majority of female participants (82.2%) reported that they started menstruating between 12-15 years old, though 44.9% reported they currently didn’t have regular periods.
Injury incidence and aetiology
Half of the respondents (53.3%) reported having at least one injury in the past 12-months (fig 2) mainly occurring during dance class (64.8%) and 25.8% of injuries required 3 days off dance. If they suspected they had an injury, 47% of respondents reported continuing dancing. Only 33.3% sort professional medical treatment, 47% took their own preventative steps, whilst 20.7% did nothing.
The injuries were mainly muscular in nature (70.9%), followed by joint/ligaments (70.7%), bone (33.2%) and tendon (30.9%) (fig 3) with the majority in the lower limb, followed by the upper limb and neck (fig 4), in all instances males reported a higher incidence than females.
Respondents thought the main cause of their injury was a reoccurrence of an old injury (53.7%) followed by fatigue (45.9%) and overwork (43.9%) (fig 5).
The majority (89.9%) had to pay for their own treatment and used masseurs (40%), GPs (39%), chiropractors (29%), physiotherapists (23%) to treat their injuries. The decision to return to dancing was mainly themselves (60.1%) or their teacher (25.2%), medical guidance accounted for just 7.7%.
Twenty percent of the respondents reported having psychological issues over the last 12-months. They were general anxiety (44.52%), constant tiredness (36.73%), burnout (28.65%), tension with people (28.37%), general low self-confidence (27.6%), eating problems (26.73%), sudden drop in self-confidence (21.35%) and performance anxiety (20.87%) (fig 6). The majority (69%) reported they didn’t have access to a counsellor/psychologist, though only 15% of those that did utilized this service.
Comparison with Fit to Dance 2 survey
The current survey had a similar number of respondent to the second Fit to Dance Survey (n=1056), though there were a slightly higher percentage of males respondees in later survey (24% male). In both surveys student dancers accounted for the majority of respondents (84% and 75%); though in the current study the majority if dancers reported their main dance genre to be Chinese Folk or Traditional dance, which obviously didn’t reflect the respondents in the UK Fit to Dance surveys. It must be remembered that the UK is 13 years out of date and may not reflect the current dance environment or practices.
The smoking rate was lower in the Chinese study (13%) than the Fit to Dance 2 (21%), whilst 29% of the Chinese reported alcohol consumption that equated to 82% in the Fit to Dance 2 report. In comparison with their general populations, Chinese dancers reported having lower smoking and alcohol rates (smoking 13% vs 30%; alcohol 29% vs 43%) whilst the Fit to Dance 2 data indicated higher rates in the UK (smoking 21% vs 17%; alcohol 82% vs 79%). The Chinese study reported a much higher incidence of following a weight reducing eating plan (57% vs 23%) and psychological issues with eating (27% vs 24%). The majority of female participants (China 82%, UK 78%) reported that they started menstruating between 12-15 years old, though the rate of irregular periods was 45% in China vs 36% in the Fit to Dance 2 report. In both surveys, media/literature was the main source of nutritional advice (China 46%, UK 39%), though in the UK the next main source was reported to be company/staff (33%) and friends (China, 31%). Nutritional supplementation was higher in the UK (63%) than in China (35%); multivitamins (China 68%, UK 56%) and calcium (China 44%, UK 20%) were reported to be the main supplements taken.
Self-reported injury incidence (at least one injury in the past 12-months) was vastly different between the two surveys with an incident rate of 53% from the Chinese survey compared to 80% in the Fit to Dance 2 report. In both surveys muscle (China 71%, UK 49%) and joint/ligament (China 71%, UK 39%) injuries were the most prevalent, though bone injuries were greater than tendon injuries (33% vs 31%) in the Chinese study and the opposite order in the UK study (tendon 21% vs bone 18%). Similar percentages continued to dance carefully if they suspected they had an injury (China 47%, UK 52%), but only 33% sort professional medical support in the Chinese survey compared to 60% in the Fit to Dance 2 report and 21% and 6%, respectively, did nothing. The prevalent sites of injury differed between the two surveys, probably due to the differing dominant dance genres. In both surveys the knee, foot and ankle were the most injured sites but in the Chinese study the neck, shoulder and arms/hands were the next leading sites whilst lower body sites (lower leg, thigh) maintained their dominance in the Fit to Dance 2 survey. The three main perceived causes of injury of injury was the same for both surveys: reoccurrence of an old injury (China 54%, UK 27%) followed by fatigue (China 46%, UK 28%) and overwork (China 44%, UK 32%).
In the Fit to Dance 2 survey, 92% of dancers reported psychological problems which is an enormous difference with the data from the current Chinese survey (20%). The perceived causes differed greatly between the two surveys In the Fit to Dance 2 survey the most prevalent problems were tension with people (60%), constant tiredness (55%), low self-esteem (53%), external stressors (48%), sudden drop in confidence (42%), and depression (40%). Whilst in the Chinese survey, they were general anxiety (45%), constant tiredness (37%), burnout (29%), tension with people (28.37%), general low self-confidence (27.6%), eating problems (26.73%), and sudden drop in self-confidence (21.35%). More respondents said they had access to counselling in the Fit to Dance 2 survey (50%) compare to the Chinese survey (31%).
In summary, there are similarities and notable differences between the two surveys, which could be accounted for by the differences in culture and dominant dance forms. It must also be remembered the that Fit to Dance 2 survey was carried out over 10 years ago and may not reflect the current situation in the UK. The more data will be reported after further analysis.
Yanan Dang is a full-time student on the MSc Dance Science course at the University of Wolverhampton. She received support for her studies from the China Scholarship Council.
Matthew Wyon is a Professor in Dance Science and MSc Dance Science course leader at the University of Wolverhampton. He also teaches on the new BSc (HONS) Dance Science and Performance degree at the university. The University of Wolverhampton is a founding partner of NIDMS
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