Dance injury monitoring, strength and conditioning training for decreasing injury incidence for Chinese pre-professional dancers

A thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.The high prevalence of dance injuries affects elements of training, rehearsals, performance, and even the daily lives of those involved. Therefore, reducing and preventing dance injuries is an ultimate goal. Previous studies have evidenced that greater levels of physical fitness have been linked to decreased injury incidence and improved dance performance, whilst they had not been reviewed. The systematic review, for the first time, systematically reviewed the efficacy of physical fitness training on dance injury. It included 10 studies that met the inclusion criteria from an initial 2450 publications. These studies offered physical fitness training for professional (n = 3) and pre-professional dancers (n = 7), participant sample size ranged between 5 to 62, ages from 11 to 27 years, and most participants were females. Assessment scores were classified as Fair (n = 1), Limited (n = 7), and Expert Opinion Only (n = 2) and risk of bias scores ranged from 22.7% to 68.2 %. After physical fitness training, 80 % of studies reported significant benefits in injury rate, the time between injuries, pain intensity, pain severity, missed dance activities and injury count. This review suggests that physical fitness training could have a beneficial effect on injury incidence in dance. The evidence is limited by the current study methodologies. Based on this evidence, the following studies (studies 1-4) focused on improving the level of evidence in study design, dance injury tracking methods, physical fitness training content and load, and dance injury reduction. In addition, previous research has mostly focused on Western populations, with only a few studies examining Chinese dancers. Therefore, using exclusively Chinese dancers, the aims of this thesis were fourfold: (a) to investigate and compare injury prevalence, causes, and risk factors before and during the COVID-19 lockdown, (b) to develop a dance injury monitoring tool on a weekly basis and examine its efficacy of weekly reporting and respondent compliance, (c) to determine injury incidence and injury severity of Chinese full-time pre-professional dancers using the injury monitoring tool, and (d) to examine the efficacy of strength and conditioning training on dance injury, physical fitness, and dance performance. Study 1 investigated dance injury in 2086 full-time Chinese pre-professional dancers pre- and post-COVID lockdown. Self-reports revealed that injury prevalence dropped significantly from 39.6% to 16.5% during this period (p<0.01). During the lockdown, the injuries on the lower back, feet and shoulders decreased significantly (p<0.01), but the knee, ankle and groin joint injuries remained the same. Fatigue and the recurrence of an old injury remained reported as the top two perceived causes of an injury between the two periods. Study 2 developed a weekly online dance injury monitoring tool and examined its efficacy. A total of 756 respondents from 16 different Chinese dance schools engaged in the survey. Over a two-semester period, the dropout rate was 70.1%, with student respondents under 18 years of age having a slightly lower drop-out rate than adult respondents (69% vs 71%). It was concluded that the researchers would need to weigh reduced completion rates (<100%) against data efficacy to achieve generalizability. Study 3 determined dance injury incidence and severity in full-time Chinese pre-professional dancers using the injury monitoring tool developed in Study 2. A total of 450 individuals’ data from 11 different schools were included in the analyses. The injury prevalence was 64.9%, and the injury incidence was 5.51 injuries per 1000 hours. Forty-eight percent of the injuries were minor severity and 41% were of moderate severity. Female dancers are at a higher risk of injury and reported higher levels of injury severity than male dancers (p<0.001). Study 4 examined the effects of a strength and conditioning training intervention on dance injury, physical fitness and dance performance. A total of 89 full-time pre-professional dancers participated. Sixty-seven dancers volunteered for a 12-week strength and conditioning training intervention (2-session/week, 40-60-min/session), and 22 dancers acted as controls. The injury was self-reported using the dance injury monitoring tool (Study 2). The intervention group significantly increased physical fitness (p0.05). The intervention group reported lower injury prevalence (28% vs 15%, p<0.001) and injury incidence (8.09 vs 5.16 injuries per 1000hrs, p<0.05) than the previous year. In conclusion, this thesis examined dance injury epidemiology following the COVID-19 arrival for a sizable sample size of Chinese pre-professional dancers and then determined injury incidence at a higher level of evidence using an innovative self-developed dance injury monitoring tool. Building on this, this thesis reinforced the positive effect of strength and conditioning training on dance injury incidence. The thesis has contributed to moving one step closer to reducing and preventing dance injuries and enriching the diversity of participants in dance injury studies.China Scholarship Council

Fit to Dance Survey: elements of lifestyle and injury incidence in Chinese dancers

This is an accepted manuscript of an article published by Science & Medicine, Inc in Medical Problems of Performing Artists on March 2020, available online: https://doi.org/10.21091/mppa.2020.1002 The accepted version of the publication may differ from the final published version.The Fit to Dance survey has been conducted a number of times using primarily Western participants and has provided foundation data for other studies. The purpose of the current study was to replicate the Fit to Dance 2 survey focusing on features of health and injuries in pre-professional and professional Chinese dancers of different genres. Results revealed that respondents (n=1040) were from Chinese Folk dance (44.4%), Chinese Classical Dance (25.6%), ballet (10.2%) and contemporary dance (9.8%). Compared to the Fit to Dance 2 survey, alcohol consumption (29% vs 82%; p<0.01) and smoking (13% vs 21%; p<0.05) were significantly less in Chinese dancers, but a higher percentage reported using weight reducing eating plans (57% vs 23%; p<0.01) or having psychological issues with food (27% vs 24%; p<0.05). Reported injuries in a 12-month period prior to data collection were significantly lower in the current survey (49% vs 80%; p<0.01). The type of injury (muscle and joint/ligament) and perceived cause of injury (fatigue, overwork and reoccurrence of an old injury) were the same in both the current and previous survey. Mean injury rate for the studied 12-month period ranged from 4.9 injuries per dancer (contemporary) to 3.4 injuries per dancer (Chinese Folk dance) which is comparable to previously reported data on western dance populations. This survey has provided the first comprehensive data on the health and injury incidence of Chinese dancers

Azorhizobium caulinodans c-di-GMP phosphodiesterase Chp1 involved in motility, EPS production, and nodulation of the host plant

Establishment of the rhizobia-legume symbiosis is usually accompanied by hydrogen peroxide (H2O2) production by the legume host at the site of infection, a process detrimental to rhizobia. In Azorhizobium caulinodans ORS571, deletion of chp1, a gene encoding c-di-GMP phosphodiesterase, led to increased resistance against H2O2 and to elevated nodulation efficiency on its legume host Sesbania rostrata. Three domains were identified in the Chp1: a PAS domain, a degenerate GGDEF domain, and an EAL domain. An in vitro enzymatic activity assay showed that the degenerate GGDEF domain of Chp1 did not have diguanylate cyclase activity. The phosphodiesterase activity of Chp1 was attributed to its EAL domain which could hydrolyse c-di-GMP into pGpG. The PAS domain functioned as a regulatory domain by sensing oxygen. Deletion of Chp1 resulted in increased intracellular c-di-GMP level, decreased motility, increased aggregation, and increased EPS (extracellular polysaccharide) production. H2O2-sensitivity assay showed that increased EPS production could provide ORS571 with resistance against H2O2. Thus, the elevated nodulation efficiency of the increment chp1 mutant could be correlated with a protective role of EPS in the nodulation process. These data suggest that c-di-GMP may modulate the A. caulinodans-S. rostrata nodulation process by regulating the production of EPS which could protect rhizobia against H2O2

Injury incidence and severity in Chinese pre-professional dancers: a prospective monitoring survey

Abstract of a presentation delivered at IADMS 33rd Annual Conference: Columbus, Ohio, October 12-15, 2023

The efficacy of strength and conditioning training on dance injury in pre-professional dancers

Abstract of a presentation delivered at IADMS 33rd Annual Conference: Columbus, Ohio, October 12-15, 2023

Prevalence and risk factors of dance injury during COVID-19: a cross-sectional study from university students in China

© (2021) The Authors. Published by Frontiers Media. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.3389/fpsyg.2021.759413Objectives: Although COVID-19 has transformed dancers’ training environment worldwide, little is known on how this has affected injury prevalence, causes and risk factors. Methods: An online investigation was conducted (September to November 2020) involving Chinese full-time dance students, which covered two 6-month periods just before and during the first COVID-19 lockdown. Results: 2086 students (19 ±2.4yrs) responded. Injury prevalence before lockdown dropped from 39.6% to 16.5% during lockdown (p<0.01). A significant increase in injury severity during lockdown was noted with a 4.1% increase in moderate to severe injuries (p<0.05). During the lockdown, injuries of the lower back, feet and shoulders decreased significantly (p<0.01), but the knees, ankles and groin/hip-joint injuries remained the same. Recurrence of old injury and fatigue remained as the top 2 perceived causes of injury between the two periods with unsuitable floor (p<0.01), cold environment (p<0.05) and set/props (p<0.05) increasing. Students’ fatigue degree decreased (p<0.01) and sleep hours increased (p<0.01) during lockdown. Binary logistic regression analysis indicated that dance injury was associated with fatigue, hours of sleep, and action taken if they suspected an injury during lockdown (p<0.05), but was only related to time set aside for cool-down and age before lockdown (p<0.05). Conclusion: Although the injury prevalence dropped significantly during the first COVID-19 lockdown in Chinese dance students, the main dance injury characteristics remained the same. Decreased fatigue and longer sleep hours could explain the aforementioned drop in injury prevalence during the lockdown.This work was supported by the China Scholarship Council for their financial contribution (D.Y

The Distribution Characteristics and Human Health Risks of High- Fluorine Groundwater in Coastal Plain: A Case Study in Southern Laizhou Bay, China

High-F groundwater has caused serious human health problems worldwide. In this paper, a typical saline-fresh water mixing zone (SFMZ) in a coastal plain (south of Laizhou Bay, China) was chosen as an example to analyze and summarize the distribution characteristics and enrichment mechanism human health risks of high-fluorine groundwater. Thirty-two groundwater samples have F- concentrations that exceed the drinking water guideline value of the World Health Organization (WHO; 1.5 mg/L), Thirty-two groundwater samples exceeded the drinking water guideline value of the WHO (1.5 mg/L) and 43 groundwater samples exceeded the National Sanitary Standard for drinking water of China (1.0 mg/L), accounting for 68.1 and 91.5% of the total groundwater samples. The groundwater quality is relatively poor in this study area, and the water is unsuitable for human consumption. High-F groundwater is mainly found in the central and northern parts of the study area, and the concentrations increase in the direction of water flow. High-F groundwater is mainly found in the central and northern parts of the study area, and the concentrations increase in the direction of water flow. According to the analysis, the groundwater environment, saline water intrusion (SWI), evaporation and cation exchange are the main factors influencing the enrichment of F in the SFMZ. The neutral and weakly alkaline environment is conducive to the enrichment of F-. Cation exchange and evaporation are the most important factors in the enrichment of F. Human activity is not the main source of groundwater F. Na+ and HCO3- are adequately abundant in the groundwater environment in the study area, creating conditions that are conducive to the dissolution of fluorite and the release of F into the groundwater. An increase in the Na+ concentration and a decrease in the Ca2+ concentration can promote further dissolution of fluorite and other F-containing minerals, thereby releasing F- into the groundwater. Fluorite dissolution is prevalent in the groundwater environment, which can lead to an increase in the F concentration. This study is helpful to the development of strategies for the integrated management of high-F groundwater in coastal plains. The health risk assessment shows that long-term exposure to high-F groundwater can pose a great threat to four age clusters, especially for children and infants. The HQ values for shallow groundwater range from 0.32 to 2.89, 0.39 to 3.61, 0.56 to 5.11, and 0.42 to 3.85 for adults, teenagers, children and infants, respectively. The groundwater in this study area is not for irrigation and animal husbandry, which may indirectly affect human health

Injury incidence and severity in Chinese pre-professional dancers: a prospective weekly monitoring survey

This is an author's accepted manuscript of an article due to be published by Elsevier in Journal of Science and Medicine in Sport. The accepted manuscript may differ from the final published version.Objective: To determine dance injury incidence and severity in full-time Chinese pre-professional dancers. Study Design: Prospective weekly online monitoring survey Methods: Respondents were asked to record all dance-injury incidences between September 2020 to July 2021 using a remote weekly self-report injury monitoring tool. An inclusive definition of injury was used in this study to record all injuries, even if they didn’t cause a cessation of training. Data were excluded if respondents completed less than 90% of the survey period and had over 3 consecutive weeks of missing data. Results: 450 individuals from 11 different schools were included in the analyses. A total of 1157 injuries were reported over a 30-week academic year. Injury prevalence was 64.9% and injury incidence was 5.51 injuries per 1000 hours. Forty-eight percentage of the injuries were minor severity and 41% were of moderate severity, and the main injury sites were knees (0.89/1000hrs), lower back (0.80/1000hr), feet (0.58/1000hrs), groin (0.56/1000hrs). Female dancers reported significantly higher injury prevalence and injury incidence, and higher rates of moderate to severe injuries than males. The university group reported higher injury incidence than the adolescent group (p<0.05), whereas the latter reported higher rates of moderate to severe injuries than the former (p<0.001). Conclusion: The injury incidence found in this study (5.1 injuries/1000hrs) is higher than most previous sets of data. Female dancers are at a higher risk of injury and reported higher levels of injury severity than male dancers, especially for the female adolescent group

The efficacy of the physical fitness training on dance injury: A systematic review

This is an accepted manuscript of an article due to be published by Georg Thieme Verlag. The accepted version of the publication may differ from the final published version.Greater levels of physical fitness have been linked to improved dance performance and decreased injury incidence. The aim was to review the efficacy of physical fitness training on dance injury. The electronic databases CINAHL, Cochrane Library, PubMed, Web of Science, MEDLINE, China National Knowledge Infrastructure were used to search peer-reviewed published articles in English or Chinese. Studies were scored using Strength of the Evidence for a Conclusion and a risk bias checklist. 10 studies met the inclusion criteria from an initial 2450 publications. These studies offered physical fitness training for professional (n=3) and pre-professional dancers (n=7), participant sample size ranged between 5 to 62, ages from 11 to 27 years, and most participants were females. Assessment scores were classified as Fair (n=1), Limited (n=7), and Expert Opinion Only (n=2) and risk of bias scores ranged from 22.7- 68.2%. After physical fitness training, 80% of studies reported significant benefits in injury rate, the time between injuries, pain intensity, pain severity, missed dance activities and injury count. This review suggests that physical fitness training could have a beneficial effect on injury incidence in dance. The evidence is limited by the current study methodologies