Joint Hypermobility as a Predictor of Mechanical Loading in Dancers

in Journal of Sport Rehabilitation
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $74.00

1 year subscription

USD  $99.00

Student 2 year subscription

USD  $141.00

2 year subscription

USD  $185.00

Context: Dance requires the performance of complex movements that may exceed normal anatomical range. However, in hypermobile individuals, this may have implications for injury and performance. Objectives: The aim of the study was to investigate the efficacy of the Beighton score (BS) in predicting mechanical loading in dancers in hypermobile and nonhypermobile dancers with consideration of accelerometer placement and lumbar flexion hypermobility. Design: Cohort study, clinical measurement. Setting: University. Participants: A total of 34 dancers had their joint hypermobility assessed by the BS. Participants completed the Dance Aerobic Fitness Test with a global positioning device incorporating a triaxial accelerometer located at the cervico-thoracic junction (C7) and one at the midbelly of the gastrocnemius. Main Outcome Measures: Accelerometry data were used to calculate PlayerLoad total, PlayerLoad medial-lateral, PlayerLoad anterior–posterior, and PlayerLoad vertical. Physiological response was measured via heart rate and fatigue response by rate of perceived exertion. Results: The total BS was a poor predictor of all mechanical loading directions with PlayerLoad anterior-posterior C7 (r = .15) and PlayerLoad total lower limb (r = .20) the highest values. Multiple linear regression was a better predictor with values of C7 (r = .43) and lower limb (r = .37). No significant difference existed between hypermobile and nonhypermobile subjects for mechanical loading values for all stages of the Dance Aerobic Fitness Test and for heart rate and fatigue responses. Conclusions: The BS is not a good predictor of mechanical loading which is similar in hypermobile and nonhypermobile dancers for all levels of the Dance Aerobic Fitness Test. Mechanical loading and fatigue responses are similar between hypermobile and nonhypermobile dancers.

The authors are with Sports Injuries Research Group, Department of Sport & Physical Activity, Edge Hill University, Ormskirk, Lancashire, United Kingdom.

Armstrong (armsross@edgehill.ac.uk) is corresponding author.
  • 1.

    Kakichová M. Biomechanical analysis of the basic classical dance jump-The grand Jeté. Int Scholarly Sci Res Innov. 2011;5(11):1363–1367.

    • Search Google Scholar
    • Export Citation
  • 2.

    Ricard MD, Veatch S. Effect of running speed and aerobic dance jump height on vertical ground reaction forces. J Appl Biomech. 1994;10:14–27. doi:10.1123/jab.10.1.14

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Rousanoglou EN, Boudolos KD. Ground reaction forces and heart rate profile of aerobic dance instructors during a low and high impact exercise programme. J Sports Med Phys Fitness. 2005;45:162–170. PubMed ID: 16355076

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Luke A, Kinney S, D’Hemecourt PA, Baum J, Owen M, Micheli LJ. Determinants of injuries in young dancers. Med Probl Perform Art. 2002:17:105–112.

    • Search Google Scholar
    • Export Citation
  • 5.

    Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A. A framework for the classification of joint hypermobility and related conditions. Am J Med Genet C Semin Med Genet. 2017;175:148–157. PubMed ID: 28145606 doi:10.1002/ajmg.c.31539

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32:413–418. PubMed ID: 4751776 doi:10.1136/ard.32.5.413

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Remvig L, Jensen DV, Ward RC. Are diagnostic criteria for general joint hypermobility and benign joint hypermobility based on reproducible and valid tests? A review of the literature. J Rheumatol. 2007;34:798–803. PubMed ID: 17295436

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Remvig L, Flycht L, Christensen KB, Juul-Kristensen B. Lack of consensus on tests and criteria for generalised joint hypermobility, Ehlers-Danlos syndrome: hypermobile type and joint hypermobility syndrome. Am J Med Genet. 2014;164(3):591–596. PubMed ID: 24464988 doi:10.1002/ajmg.a.36402

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Armstrong R. Relative joint contribution to joint hypermobility: the need for careful consideration of lumbar flexion. Int J Sports Phys Ther. 2018;13(4):676–686. PubMed ID: 30140561 doi:10.26603/ijspt20180676

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Klemp P, Learmonth ID. Hypermobility and injuries in a professional ballet company. Br J Sports Med. 1984;18:143–148. PubMed ID: 6435713 doi:10.1136/bjsm.18.3.143

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Klemp P, Stevens JE, Isaacs SA. A hypermobility study in ballet dancers. J Rheumatol. 1984;11:692–696. PubMed ID: 6334748

  • 12.

    Bronner S, Bauer NG. Risk factors for musculoskeletal injury in elite pre-professional modern dancers: a prospecitve cohort prognostic study. Phys Ther Sport. 2018;31:42–51. PubMed ID: 29597115 doi:10.1016/j.ptsp.2018.01.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Gannon LM, Bird HA. The quantification of joint laxity in dancers and gymnasts. J Sports Sci. 1999;17:743–750. PubMed ID: 10521005 doi:10.1080/026404199365605

  • 14.

    Wyon M, Redding E, Abt G, Head A, Sharp NCC. Development, reliability, and validity of a multistage Dance-specific Aerobic Fitness Test (DAFT). J Dance Med Science. 2003;7:80–84.

    • Search Google Scholar
    • Export Citation
  • 15.

    Barrett S, Midgley A, Lovell R. PlayerLoad™: reliability, convergent validity and influence of unit positon during treadmill running. Int J Sports Physiol Perform. 2014;9:945–952. doi:–10.1123/ijspp20130418

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Halsey LG, Shepard EL, Wilson RP. Assessing the development and application of the accelerometry technique for estimating energy expenditure. Comp Biochem Physiol A Mol Integr Physiol. 2011;158(3):305–314. PubMed ID: 20837157 doi:10.1016/j.cbpa.2010.09.002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Brogden CM, Armstrong R, Page R, Milner D, Norris D, Greig M. Use of triaxial accelerometry during the dance aerobic fitness test: considerations for unit positioning and implications for injury and performance. J Dance Med Sci. 2018;22(3):115–122. PubMed ID: 30139416 doi:10.12678/1089-313X.22.3.115

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Armstrong R, Brogden C, Greig M. The star excursion balance test as a predictor of mechanical loading and performance in dancers [published online ahead of print January 19, 2018]. Gazzetta Medica Italiana.

    • Search Google Scholar
    • Export Citation
  • 19.

    Armstrong R, Brogden C, Milner D, Norris D, Greig M. Functional Movement Screening as a predictor of mechanical loading and performance in dancers [published online ahead of print January 31, 2018]. J Dance Med Sci. 2018;22(4): 203–208. doi:10.12678/1089-313X.22.4.203

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Gray GW. Lower Extremity Functional Profile. Adrian, MI: Wynn Marketing, Inc; 1995.

  • 21.

    Gribble P, Hertel J. Considerations for normalising measures of the star excursion balance test. Meas Phys Educ Exerc Sci. 2003;7(2):89–100. doi:10.1207/S15327841MPEE0702_3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Batson G. Validating a dance-specific screening test for balance. Med Probl Perform Art. 2010;25:110–115. PubMed ID: 21120268

  • 23.

    Cook G, Burton L, Hoogenboom B. Pre-participation screening: the use of fundamental movements as an assessment of function - part 1. N Am J Sports Phys Ther. 2006;1(2):62–72. PubMed ID: 21522216

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Cook G, Burton L, Hoogenboom B. Pre-participation screening: the use of fundamental movements as an assessment of function - part 2. N Am J Sports Phys Ther. 2006;1(3):132–139. PubMed ID: 21522225

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970;2:92–98. PubMed ID: 5523831

  • 26.

    Chorba R, Chorba DJ, Bouillon LE, Overmyer CA, Landis JA. Use of a functional movement screening tool to determine injury risk in female collegiate athletes. N Am J Sports Phys Ther. 2010;5(2):47–54. PubMed ID: 21589661

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Kline C, Durstine J, Davis J, et al. Circadian variation in sports performance. J Appl Physiol. 2007;102:641–649. PubMed ID: 17095634 doi:10.1152/japplphysiol.00910.2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Juul-Kristensen B, Røgind H, Jensen DV, Remvig L. Inter-examiner reproducibility of tests and criteria for generalized joint hypermobility and benign joint hypermobility syndrome. Rheumatology. 2007;46:1835–1841. PubMed ID: 18006569 doi:10.1093/rheumatology/kem290

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Bird HA. Rheumatological aspects of dance. J Rheumatol. 2004;31:12–13. PubMed ID: 14705211

  • 30.

    Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005;19:231–240. PubMed ID: 15705040

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Boyd LJ, Ball K, Aughey RJ. The reliability of MinimaxX accelerometers for measuring physical activity in Australian Football. Int J Sports Physiol Perform. 2011;6:311–321. PubMed ID: 21911857 doi:10.1123/ijspp.6.3.311

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. New York, NY:Psychology Press; 1988.

  • 33.

    Bowerman BL, O’Connell RT. Linear Statistical Models: An Applied Approach 2nd ed. Belomt, CA: Duxbury; 1990.

  • 34.

    Myers R. Classical and Modern Regression Applications. 2nd ed. Boston, MA: Duxbury; 1990.

  • 35.

    Menard S. Applied Logistic Regression Analysis. 2nd ed. Thousand Oaks, CA: Sage; 2002.

  • 36.

    Nedergaard NJ, Robinson MA, Eusterwiemann E, Drust B, Lisboa PJ, Vanrenterghen J. The relationship between whole-body external loading and body-worn accelerometry during team sports movements. Int J Sports Physiol Perform. 2017;12(1):18–26. PubMed ID: 27002795 doi:10.1123/ijspp.2015-0712

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Ericson WB, Wolman R. Orthopaedic management of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175:188–194. PubMed ID: 28192621 doi:10.1002/ajmg.c.31551

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Macintyre J, Joy E. Foot and ankle injuries in dance. Clin Sports Med. 2000;19(2):351–368. PubMed ID: 10740764 doi:10.1016/S0278-5919(05)70208-8

  • 39.

    Aydin E, Tellioglu AM, Ömürlü IK, Turan T. Impact of generalised joint laxity on plantar loading patterns in young females. Foot Ankle Int. 2017;38(8):909–915. PubMed ID: 28656782 doi:10.1177/1071100717709567

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Foss KD, Ford KR, Myer GD, Hewett TE. Generalized joint laxity associated with increased medial foot loading in female athletes. J Athl Train. 2009;44(4):356–362. PubMed ID: 19593417 doi:10.4085/1062-6050-44.4.356

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Wyon MA, Redding E. Physiological monitoring of cardiorespiratory adaptations during rehearsal and performance of contemporary dance. J Strength Cond Res. 2005;19(3):611–614. PubMed ID: 16095410

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Voermans NC, Knoop H. Both pain and fatigue are important possible determinants of disability with Ehlers-Danlos syndrome hypermobility type. Disabil Rehabil. 2011;33(8):706–707. PubMed ID: 21077749 doi:10.3109/09638288.2010.531373

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Voermans NC, Knoop H, Bleijenberg G, van Engelen BG. Fatigue is associated with muscle weakness in Ehlers-Danlos syndrome: an explorative study. Physiotherapy. 2011;97(2):170–174. PubMed ID: 21497252 doi:10.1016/j.physio.2010.06.001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Celletti C, Galli M, Cimolin V, Castori M, Albertini G, Camerota F. Relationship between fatigue and gait abnormality in Joint Hypermobility Syndrome/ Ehlers Danlos Syndrome Hypermobility type. Res Dev Disabil. 2012;33(6):1914–1918. PubMed ID: 22819599 doi:10.1016/j.ridd.2012.06.018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Schmit JM, Regis DI, Riley MA. Dynamic patterns of postural sway in ballet dancers and track athletes. Exp Brain Res. 2005;163(3):370–378. PubMed ID: 15655686 doi:10.1007/s00221-004-2185-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Simmons RW. Sensory organization deterimants of postural stability in trained ballet dancers. Int J Neurosci. 2005;115(1):87–97. PubMed ID: 15768854 doi:10.1080/00207450490512678

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Smith TO, Jerman E, Easton V, et al. Do people with benign joint hypermobility syndrome (BJHS) have reduced joint proprioception? A systematic review and meta-analysis. Rheumatol Int. 2013;33(11):2709–2716. PubMed ID: 23728275 doi:10.1007/s00296-013-2790-4

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Marulli TA, Harmon-Matthews LE, Davis-Coen JH, Willigenburg NW, Hewett TE. Eyes closed single-limb balance is not related to hypermobility status in dancers. J Dance Med Science. 2017;21(2):70–75. PubMed ID: 28535850 doi:10.12678/1089-313X.21.2.70

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49.

    Wild CY, Grealish A, Hopper D. Lower limb and trunk biomechanics after fatigue in competitive female Irish dancers. J Athl Train. 2017;52(7): 643–648. PubMed ID: 28437130 doi:10.4085/1062-6050-52.3.12

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Quatman CE, Ford KR, Myer GD, Paterno MV, Hewett TE. The effect of gender and maturational status on generalized joint laxity in young athletes. J Sci Med Sport. 2008;11:257–263. PubMed ID: 17597005 doi:10.1016/j.jsams.2007.05.005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51.

    Russek LN. Hypermobility syndrome. Phys Ther. 1999;79:591–599. PubMed ID: 10372870

All Time Past Year Past 30 Days
Abstract Views 84 84 34
Full Text Views 12 12 2
PDF Downloads 5 5 1