title: Incidence and Prevalence of Musculoskeletal Injury in Ballet: A Systematic Review.
abstract: BACKGROUND
  Most published studies on injuries in the ballet dancer focus on the lower extremity. The rigors of this activity require special training and care. By understanding prevalence and injury pattern to the musculoskeletal system, targeted prevention and treatment for this population can be developed.
  
  
  OBJECTIVE
  To determine the incidence and prevalence of musculoskeletal injuries in ballet.
  
  
  METHODS
  Systematic review; Level of evidence, 4.
  
  
  METHODS
  A systematic review registered with PROSPERO was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Level 1 through 4 evidence studies reporting incidence of musculoskeletal injuries in male and female ballet dancers were included, with the numbers and types of injuries extracted from each. Injury rates were recorded and calculated based on professional status, sex, and nature of injury. Incidence was defined as number of injuries sustained over a specific time. Prevalence was defined as proportion of subjects with an injury at a given point in time.
  
  
  RESULTS
  The studies analyzed reported injury incidence or prevalence in more than 1365 amateur and 900 professional dancers. The mean age was 16.2 years among amateur and 27.0 years among professional dancers. The incidence of injury among amateur dancers was 0.99 and 1.09 injuries per 1000 dance hours in males and females, respectively; 75% of injuries were overuse, with similar rates among males and females. In professional dancers, the incidence of injury was 1.06 and 1.46 injuries per 1000 dance hours in males and females, respectively, and 64% of female injuries were overuse, compared with 50% in males (P < .001). Only 3 studies provided prevalence data, including 62% prevalence of lumbosacral pain, 58% painful snapping hip, and 29% patellofemoral pain. Lower extremity injuries comprised 66% to 91% of all injuries, with the foot and ankle accounting for 14% to 57%.
  
  
  CONCLUSIONS
  The overall incidence of injury among amateur and professional ballet dancers is 0.97 and 1.24 injuries per 1000 dance hours, respectively. The majority are overuse in both amateur and professional dancers, with amateur ballet dancers showing a higher proportion of overuse injuries than professionals (P < .001). Male professional dancers show a higher proportion of traumatic injuries, accounting for half of their injuries (P < .001).
authors.affiliation: Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Preston J
authors.initials: PJ
authors.lastname: Smith
authors.affiliation: Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Brayden J
authors.initials: BJ
authors.lastname: Gerrie
authors.affiliation: Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Varner
authors.affiliation: Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: McCulloch
authors.affiliation: Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Lintner
authors.affiliation: Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Harris
keywords: ballet dance injury; musculoskeletal injury; overuse injuries