DIS-TANZ DIARY #8

SO, WHAT ABOUT SCREENING?

Jan 30, 2021 in DIS-TANZ-SOLO

Dance Injury Prevention Screening Header Photo

I always disliked the idea of health and fitness screening programs for dancers. It actually seemed that everyone in the dance community disliked that idea. Performing a full motion analysis and physical assessment of a dancer to identify deficits in strength, range of motion, balance and neuromuscular control seemed like a scary thing. Already being subjected to a single test seemed scary and unnecessary. Why would you let yourself be judged solely based on your physical disposition? Wasn’t that an old-fashioned approach? Weren’t artistic abilities much more important?

I must confess that I knew screening only as a synonym for an aptitude test, e.g. for the selection of dancers after an assessment of their physical qualifications at an audition. I was not aware that the term was simply a victim of unclear terminologies. An aptitude test is designed to identify and evaluate performance limitations. A functional screening, on the other hand, is meant to reveal performance resources and thus a person’s potential for development.

I recently read PREVENTING DANCE INJURIES: AN INTERDISCIPLINARY PERSPECTIVE, edited by Ruth Solomon, John Solomon, and Sandra Cerny Minton. When I got to Part III: Prevention, and specifically Chapter 8: Physical Screening of the Dancer: General Methodologies and Procedures by Janice Gudde Plastino it suddenly hit me. Gudde Plastino, who had developed the pre-participation screening program in dance at the University of California, Irvine after seeing all the injured dancers at the University Student Health Service, wrote that she came up with the program “with the hope that dance injuries can be lessened, and student dancers taught more about their own bodies”.

I suddenly came to a realization that is probably very obvious to dance science and dance medicine experts, but possibly less obvious to artists: functional screening can be a useful feedback tool for self-management and learning; a tool with the potential to optimize performance, reduce injuries and positively impact career longevity.

If I would have learned more about my own body and my specific strengths and weaknesses from a scientific / medical point of view while studying, I could have avoided a lot of struggle and reached a higher performance level much earlier in my career. I spent quite some years trying to shape my body and my dancing according to expectations imposed by teachers, choreographers, and the dance community as a whole. Only through years of experience and a few odd injuries did I learn how to utilize the potential of my body in a way that truly serves my artistry.

It’s no doubt that mastery only comes with practice and experience, there’s no shortcut. But a dancer’s career is still a short one, so if there’s a way to support young performers in their artistic development, then I definitely think it’s a way worth exploring. After all, the more information you are able to work with, the better choices you can make.

Cover PREVENTING DANCE INJURIES: AN INTERDISCIPLINARY PERSPECTIVE by Ruth Solomon, John Solomon, Sandra Cerny Minton

PREVENTING DANCE INJURIES: AN INTERDISCIPLINARY PERSPECTIVE
Edited by Ruth Solomon, John Solomon, Sandra Cerny Minton

Publisher : Human Kinetics
Language : English
Paperback : 256 pages
ISBN-10 : 0736055673
ISBN-13 : 978-0736055673
Dimensions : 21.59 x 1.5 x 27.94 cm

There are plenty of available tools and endless options when it comes to designing a dance specific screening program. Obviously it always depends on the specific information you want to gather and the specific goal you are gathering it for.

The two key elements for a reliable standardized testing tool are: validity (the extent to which the results really measure what they are supposed to measure) and reliability (the extent to which the results can be reproduced when the research is repeated under the same conditions).

Validity is in turn determined by sensitivity (the extent to which a diagnostic test correctly identifies those who have a particular condition) and specificity (the extent to which a diagnostic test correctly identifies those who do not have a particular condition). Reliability is subdivided into intra-rater reliability (the extent to which one single rater or observer of a given measure comes up with the same value of the measure for a given case) and inter-rater reliability (the extent to which different raters or observers of a given measure come up with the same value of the measure for a given case).

Here are some of the more common tests with links to explanations on their respective objectives and methods. Some of them are designed specifically for dancers, while others are aimed at athletes in general.

SCREENING TOOLS

The Beighton score is a non-dance specific system for quantifying joint laxity and hypermobility. It uses a simple 9-point system, where the higher the score, the higher the laxity. It was originally introduced for epidemiological studies aimed at detecting hypermobility in populations.
There are specific DAFT test variations for both ballet and contemporary dancers. These scientifically validated aerobic and anaerobic fitness tests were developed by dance science researchers at Trinity Laban and the University of Wolverhampton.
The Functional Movement Screen (FMS) is a non-dance specific screening tool used to evaluate seven fundamental movement patterns in individuals with no current pain complaint or musculoskeletal injury. These movement patterns are: deep squat, hurdle step, inline lunge, shoulder mobility, active straight-leg raise, trunk stability push-up, and rotary stability.
The test was designed as part of a study by Emma Redding , Peter Weller, Shantel Ehrenberg, Sarah Irvine, Edel Quin, Sonia Rafferty, Matthew Wyon, and Carol Cox to be able to observe changes in heart rate (HR), thereby allowing for a measurement of physical fitness at high intensities. The test allows dancers to be assessed within an environment that they are accustomed to (the studio), using a mode of exercise that is relevant (dance), and it is of adequate intensity to be representative of performance.
The MADAAMI-II is an instrument that has been developed and validated with the aim of providing direct, simple, and practical support for the identification of compensations and misalignments of joints during Demi-Plié, Grand Plié, and Fondu. The updated 2nd version fo the test procedure was developed by Kaanda Nabilla Souza Gontijo, Claudia Tarragô Candotti, Maiane Almeida do Amaral, Gabriela Cristina dos Santos, Valerie Williams & Jefferson Fagundes Loss.
The 
fundamental 
movement 
patterns 
that 
are 
evident
 in 
activities 
of 
daily 
living 
and 
strength
 training
 programs
 to
 varying 
degrees 
are: 
the
 squat 
pattern, 
lunge 
pattern, 
upper 
body 
push 
pattern, 
upper 
body 
pull
 pattern, 
bend 
pattern, 
twist 
pattern, 
and
 single 
leg
 squat 
pattern.
 The
 objective 
of 
the 
movement
 competency 
screen is 
to
 identify 
which 
fundamental 
movement 
patterns can 
be 
aggressively 
loaded
 and 
which
 require 
developmental 
attention.



Three functional tests (the Airplane test, Sauté test, and Topple test) were combined by Megan Richardson , Marijeanne Liederbach, and Emily Sandow in a study at the Harkness Center for Dance Injuries in NYC to generate a specific dynamic testing system in order to determine the adequacy of postural control, joint stability, and muscular power deemed necessary for successful progression to pointe work.
Range of motion refers to the potential movement of a joint from full extension to full flexion. Range of motion is a measure of the flexibility of ligaments, tendons, muscles, bones, and joints, so testing ROM is essential for determining general fitness and assessing potential damage.
The Star Excursion Balance Test is a relatively simple but somewhat time-consuming test used to measure dynamic balance control. It is a non-dance specific test that measures dynamic balance by challenging athletes to balance on one leg and reach as far as possible in eight different directions.
The Thomas test (or Hugh Owen Thomas well leg raising test) is a physical examination test used to rule out hip flexion contracture and psoas syndrome. Though it is non-dance specific in its nature, it is often associated with runners, dancers, and gymnasts who complain of hip "stiffness" and reported "snapping" feeling when flexing at the waist.
The Y-Balance Test is a simple but reliable non-dance specific test used to measure dynamic balance. It was developed to refine the lengthy process of performing the Star Excursion Balance Test.
The YMCA Level Test is a useful and easy to perform assessment to measure your cardiovascular (aerobic) fitness level. This assessment is based on your heart rate recovery, i.e. how quickly your heart rate returns to baseline after exercise. A more dance-specific version, an accelerated step test, was developed by Shaw Bronner and Sara Rakov.
In addition, there are a variety of functional tests that focus on specific areas of the body and which can serve as important indicators of movement disturbances: for example the Hip Outcome Score (HOS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), or the Cumberland Ankle Instability Tool (CAIT).
Here is a selection of scientific papers and articles that I found while researching the available information on screening tools for dancers. I am sure that there are more relevant publications, so I may expand this list in the future.

RELEVANT SCIENTIFIC PAPERS & ARTICLES

Journal of Dance Medicine and Science Cover

A New Version of the MADAAMI Method for Assessing Lower Limb Alignment During Demi-Plié, Grand Plié, and Fondu

by Kaanda Nabilla Souza Gontijo, Claudia Tarragô Candotti, Maiane Almeida do Amaral, Gabriela Cristina dos Santos, Valerie Williams & Jefferson Fagundes Loss
(Journal of Dance Medicine & Science 22/3, September 2018)

The MADAAMI (Método de Avaliação Dinâmica do Alinhamento Articular dos Membros Inferiores—Dynamic Evaluation Method of Lower Limb Joint Alignment) is an instrument that has been developed and validated with the aim of providing direct, simple, and practical support for the identification of com- pensations and misalignments of joints. The first version of the instrument had some limitations. The goals of the pres- ent study are to update the instrument (MADAAMI-II), evaluate its content validity, and verify inter-rater and intra- rater reproducibility during the execution of demi-plié, grand plié, and fondu in two turnout positions of classical ballet (120° and self-reported) and in parallel foot position.

Journal of Dance Medicine and Science Cover

A Screening Program for Dancers Administered by Dancers

by Margaret Wilson & Jennifer L. Deckert
(Journal of Dance Medicine & Science 13/3, September 2009)

Students enrolled in a dance kinesiology class were trained to administer a screening protocol on younger dancers in the same department. The dance kinesiology students gained experience assessing align- ment and functional symmetry in their peers, and then recommended exercises for gaining awareness and developing balanced patterns of movement. This “low stakes” assessment created both dialogue and peer support centered on helping the screened dancers understand and effectively work with their individual capacities and limitations. The project was designed to contribute to a culture of wellness and education within the dance department.

Journal of Dance Medicine and Science Cover

An Accelerated Step Test to Assess Dancer Pre-season Aerobic Fitness

by Shaw Bronner & Sara Rakov
(Journal of Dance Medicine & Science 18/1, March 2014)

As the technical performance demands of dance increase, professional companies and pre-professional schools are implementing pre-season screenings that require an efficient, cost effective way to measure dancer aerobic fitness. The aim of this study was to assess an accelerated 3-minute step test (112 beats·min-1) by comparing it to the well-studied YMCA step test (96 beats·min-1) and a benchmark standard, an incremental treadmill test, using heart rate (HR) and oxygen consumption (VO2) as variables.

Open Access Journal of Clinical Case Reports Cover

Dance screening practices in dance companies, dance schools and university dance programmes: An international survey of current practices

by Ross Armstrong
(Journal of Clinical Case Reports, 2019)

Dance performance requires the combination of both athletic and artistic demands. The health and well-being of dancers is of paramount importance, and one intervention that has been used to manage their health and performance is screening. The Bristol online survey was used to determine screening practices in dance companies/schools and university dance programmes. The survey was available online between April 2018 and September 2018 and consisted of 39 questions which were divided into the following sections: (1) screening details, (2) physical fitness and joint screening, (3) injury screening, (4) dance specific movement screening, (5) health screening. Respondents included those individuals involved in dance screening.

Journal of Dance Medicine and Science Cover

The Development of a High Intensity Dance Performance Fitness Test

by Emma Redding, Peter Weller, Shantel Ehrenberg, Sarah Irvine, Edel Quin, Sonia Rafferty, Matthew Wyon & Carol Cox
(Journal of Dance Medicine & Science 13/1, March 2009)

While there is currently a validated dance- specific exercise method of measuring aerobic fitness, no such test has been developed to measure high intensity capa- bilities in dance. The purpose of this study was to initiate an intermittent high inten- sity dance-specific fitness test. The test was designed to be able to observe changes in heart rate (HR), thereby allowing for a measurement of physical fitness at high intensities.

Journal of Dance Medicine and Science Cover

Development, Reliability, and Validity of a Multistage Dance Specific Aerobic Fitness Test (DAFT)

by Matthew Wyon, Emma Redding, Grant Abt, Andrew Head & N. Craig C. Sharp
(Journal of Dance Medicine & Science 7/3, September 2003)

The aim of this study was to design a multi- stage dance-specific aerobic field-test that would indicate whether a dancer had the cardiorespiratory capabilities to cope with the demands of dance class and perfor- mance. The test consisted of five progres- sively demanding dance sequences. The technical level of each stage was kept as simple as possible to reduce the effect of economy of movement so that the empha- sis of the test was physiologically based rather than skill orientated.

Journal of Dance Medicine and Science Cover

Functional Criteria for Assessing Pointe-Readiness

by Megan Richardson, Marijeanne Liederbach & Emily Sandow
(Journal of Dance Medicine & Science 14/3, September 2010)

The most popular criterion cited in the dance literature for advancement to pointe work is attainment of the chronological age of 12 years. However, dancers at this age vary greatly in terms of musculoskeletal maturity and motor skill development. The purpose of this study was to investigate whether objective, functional tests could be used in conjunction with dance teacher expertise to determine pointe-readiness. It was hypothesized that dynamic tests of motor control can better indicate pointe-readiness than chronological age alone or in combination with static musculoskeletal measurements.

The International Journal of Sports Physical Therapy Cover

INJURY INCIDENCE, DANCE EXPOSURE AND THE USE OF THE MOVEMENT COMPETENCY SCREEN (MCS) TO IDENTIFY VARIABLES ASSOCIATED WITH INJURY IN FULL-TIME PRE-PROFESSIONAL DANCERS

by Linda Lee, Duncan Reid, Jill Cadwell & Priya Palmer
(The International Journal of Sports Physical Therapy 12/3, June 2017)

Prospective studies utilizing standardized injury and exposure measures are needed to consolidate our knowledge of injury incidence and associated risk factors for musculoskeletal injury amongst pre-professional dancers. The purpose of this study was to investigate the injury incidence amongst pre-professional dancers attending a fulltime training school in New Zealand. The secondary purposes of this study were to investigate the relationship between dance exposure and injury risk, and the relationship between risk factors (specifically the MCS outcome scores) and injury risk.

Cover THE IADMS BULLETIN FOR DANCERS AND TEACHERS

Screening for Improved Dance Function

by Karen Potter, Gary Galbraith & Jane Baas
(The IADMS Bulletin for Teachers 3/1, 2011)

Imagine a world where dancers are able to learn specifics about their physical condition similar to what commonly occurs with other athletes. Then imagine that by performing some simple exercises given by the teacher and/or a team of medical professionals cognizant of the unique demands of dance, the dancer happily reports later that many of her basic dance skills have improved and she generally feels better about herself and her dancing. These worlds do ex- ist, and new ones are being created by dedicated teachers and medical professionals in dance companies, schools, conservatories, and universities.

Sports Medicine Open Cover

Screening Tools as a Predictor of Injury in Dance: Systematic Literature Review and Meta-analysis

by Ross Armstrong & Nicola Relph
(Sports Medicine - Open, 2018)

Dance involves movements of complexity and physical intensity which result in stress on the body. As a consequence, dancers are at risk of injury which can impact on their well-being. Screening tools are used for injury prevention to identify those dancers at risk of injury. The aim of this study was to investigate which screening tools can predict injury in dancers, encompassing all dance genres, levels and ages.

Medical Problems of Performing Artists Cover

The m/r SEBT: Development of a Functional Screening Tool for Dance Educators

by Margaret Wilson & Glenna Batson
(Medical Problems of Performing Artists 29/4, December 2014)

Dance screenings provide direct and indirect data bearing on a dancer’s readiness to undertake rigorous physical training. Rarely, however, are dance teachers able to translate results from these screenings into practical technical knowledge. In this article, an example of a preseason assessment tool is pre- sented that translates scientific findings into useful informa- tion for dance teachers conducting auditions. Designed as a baseline assessment of the dancer during auditioning, the m/r SEBT tool helps teachers stratify technical levels, identify injury risk, and consequently assist with immediate and appropriate recommendations for supplemental training and/or follow-up with a medical professional.

As already seen, there are a variety of standardized tests that you can more or less easily perform yourself. During my online research, I also came across a smattering of organizations that include screening programs in their portfolio of activities. Naturally, these programs vary in scope and substance, and i can't give any first hand recommendations, but the respective websites might be a good starting / contact point if you want to gather some more first-hand information about the topic.

Organizations

Post-Hire Health Screen for Professional Dancers

Dance/USA - Task Force on Dancer Health

Pre-Professional & Pre-Season Dancer Screen (Members only)

Healthy Dancer Canada

Screening, Exposure Tracking, Surveys, Injury Surveillance

Dancer Wellness Project

Screening, Performance Diagnostic, Preventative Training, Injury Surveillance

medicos.AufSchalke - Kompetenzzentrum Tanzmedizin

Annual Health Screening, Injury Prevention Assessment, Ergonomic Evaluations

NYU Langone - Harkness Center for Dance Injuries

Screening and Profiling for Professional Dancers

Trinity Laban Conservatoire of Music and Dance - Performance Optimisation Package

If you know of any organizations that you think should be included in this list, please don't hesitate to send me an email. Thank you!
Header photo by Toralf Thomassen on Unsplash
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