Does inherent joint hypermobility [IJH] increase the risk of injury in professional ballet dancers?

McCormack, Moira MSc, MCSP, Royal Ballet Company; Janet Briggs, MSc, MCSP, Royal Ballet School, London United Kingdom; Hakim, Alan MA, FRCP, University College Hospital, London, United Kingdom; and Grahame, Rodney MD, FRCP, University College Hospital, London, United Kingdom 

Background

A substantial proportion of classical ballet dancers manifest IJH (1), (defined by the Brighton criteria (2)). Those affected may be more vulnerable to injury

Aims

This study set out to document prospectively in a cohort of dancers the extent to which injuries occurred over a 5-year period and their association with IJH. 

Methods

Data were collected from 50 dancers in 2002 in order to establish whether or not individual dancers conformed to the IJH criteria. In 2007 a questionnaire enquired as to any injuries sustained, musculoskeletal ailments suffered, and the occurrence of any resultant episodes (> 6 weeks duration) of time lost from dancing. Ethical approval was granted. Odds ratios (OR, 95% CI) were calculated for injury risk associated with IJH. 

Results

Analysing  the data distributed according to  sex, IJH, and injury, the following trends were identified:

Joint pain was universal; mean number of joints involved and distribution of spinal pain did not vary significantly.

A non-significant increased reporting of ankle trauma in IJH females OR 2.27 (0.64-8.05) p=0.2, muscle tears in the same group OR 6.00 (0.57 ? 62.69) p=0.13, and shoulder capsulitis in IJH males OR 5.20 (1.34 ? 28.13) p=0.2

In both sexes IJH was strongly associated with:

Tendon injuries, OR  6.15 (1.34 ? 28.13) p=0.02

Stopping dancing > 6weeks due to injury, OR 3.34 (0.96-11.62) p=0.058. 

A third of IJH female dancers also had recurrent long-term injuries compared to peers.

Conclusion

Tendon injuries appear to be more common in dancers with IJH. Injury in the presence of IJH is associated with a more protracted recovery time, which may have implications for the professional dancer. 

Reference List

(1) Journal of Rheumatology 2004; 31(1):173-178.

(2) Journal of Rheumatology 2000; 27(7):1777-1779.

Table 1

Injury reporting expressed as the % of individuals in each subgroup answering in the affirmative

FEMALES

MALES

IJH

Non IJH

IJH

Non IJH

Number

11

18

7

14

Any joint pain 

100% response ?Yes?

mean no. of sites 2.95 (sd 1.23)

100% response ?Yes?

mean no. of sites  2.28 (sd 1.36)

Neck 

pain

55%

72%

43%

77%

Dorsal pain

63%

59%

27%

46%

Lower back pain

72%

82%

71%

88%

Dislocation

Nil

12%

Nil

Ankle sprain

45%

22%

29%

21%

Tendon

36%

17%

43%

Nil

Ligament

27%

33%

43%

29%

Muscle

27%

6%

Nil

Shoulder

Nil

12%

29%

7%

Carpal Tunnel

Nil

Nil

+6 wk stop

55%

39%

100%

50%

More than one 6wk stop

36%

Nil

29%

28%

Fracture/other

18%

12%

57%

43%