Associations between 12-month lower limb injury incidence and proprioception in professional ballet dancers in the Western Cape, South Africa

Temlett, Caroline

Associations between 12-month lower limb injury incidence and proprioception in professional ballet dancers in the Western Cape, South Africa

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Health and Rehabilitation Sciences

Faculty

Faculty of Health Sciences

Abstract

Background Ballet places high physical demands on dancers' bodies, putting them at great risk of injury, particularly to their lower limbs. These injuries may negatively impair performance or shorten careers. Risk factors associated with ballet-related injuries are insufficiently described. While proprioception is an important component of dancers' physical capacity for training and performing, it is unclear if deficiencies in proprioception contribute to the risk of lower limb injuries. Aims and Objectives The aim of this study was to determine the associations between 12-month lower limb injury incidence and proprioception in professional ballet dancers in the Western Cape, South Africa. The objectives were to: describe dancers' demographic and anthropometric characteristics; describe dance exposure and lower limb injury incidence per 1000 dance hours over a 12-month period; determine dancers static and dynamic lower limb proprioception; and determine potential associations between sex, age, anthropometric variables, rank, and proprioception and lower limb injury rate. Methods A 12-month prospective study was conducted on 36 professional ballet dancers based at Cape Town City Ballet (CTCB). Participants provided written informed consent and completed pre-participation safety and demographic questionnaires. Anthropometric measurements were recorded, following which dancers completed four baseline proprioception tests, namely: the Balance Error Scoring System (BESS), the Timed Dance-Specific Positional Holds, the Y-Balance Test, and the Multiple Single Leg Hop Stabilisation Test (MSLHST). Over the 12-month study period, dancers' training loads (the number of hours danced per week) were captured using AthleteMonitoring software and their lower limb injuries were recorded using the CTCB Dancer Injury Report Form, following the International Olympic Committee (IOC) consensus statement. Results The sample comprised 22 females and 14 males (mean age 24.31 ± 3.55 years). The total dance exposure was 28 714 hours (median [IQR] dance exposure of 806.67 [484.96 - 1068.05] hours per dancer). The mean baseline BESS score was 11.36 ± 3.30 errors. The median [IQR] durations for the Timed Dance-Specific Positional Holds were: relevé hold durations were 11.10 [7.47 - 16.97] seconds (nondominant leg) and 13.65 [6.80 - 18.38] seconds (dominant leg), and passé hold durations were 8.90 [4.90 - 18.35] seconds (non-dominant leg) and 8.65 [4.97 - 15.62] seconds (dominant leg). The mean composite scores for the Y-Balance Test were 94.61 ± 6.69% (non-dominant leg) and 94.16 ± 7.09% (dominant leg), respectively. The mean scores for the MSLHST were 45.22 ± 17.19 errors (nondominant leg) and 55.56 ± 19.07 errors (dominant leg) respectively. There were 187 injuries recorded over the 12-month period. The overall adjusted lower limb injury incidence was 7.38 injuries per 1000 dance hours (95% CI: 6.36- 8.52). Most injuries were medical attention injuries (6.67 injuries per 1000 dance hours; 95% CI: 5.7-7.75), overuse in nature (6.04 injuries per 1000 dance hours; 95% CI: 5.127.07), and occurred most frequently during class (3.24 injuries per 1000 dance hours; 95% CI: 2.574.02). The lower leg was the region with the highest injury incidence (1.97 injuries per 1000 dance hours; 95% CI: 1.46-2.6), and muscles or tendons was the most common type of tissue injured (3.35 injuries per 1000 dance hours; 95% CI: 2.68-4.15). Increased age [IRR: 1.09, 95% CI (1.01-1.17); p = 0.03], being an apprentice [IRR: 0.43, 95% CI (0.24-0.73); p = 0.002], and the principal dancer [IRR: 0.23, 95% CI (0.04-0.87); p = 0.044] were independently associated with a lower injury rate. Those scoring above 11 seconds on their non-dominant leg relevé hold [IRR: 0.55, 95% CI (0.30-0.96); p = 0.04], 93.3% composite score on the Y-Balance Test on their non-dominant leg [IRR: 0.54, 95% CI (0.320.90); p = 0.019] and 43/130 errors on their non-dominant leg on the MSLHST [IRR: 0.56, 95% CI (0.350.90); p = 0.018], had a significantly lower injury rate than those who scored below those values. Conclusion Professional ballet dancers from this cohort demonstrated a high adjusted lower limb injury incidence. Most injuries were overuse in nature, frequently occurred in their lower legs, and commonly involved dancers' muscles or tendons. These findings strongly suggest the need for appropriate resources and ongoing healthcare services to be provided to help prevent and manage dancers' injuries. Although some associations were identified between proprioception and lower limb injury rate, proprioception did not appear to play a major role in injury development among this cohort of professional ballet dancers. However, the tests used may not have adequately assessed the proprioceptive ability of these highly trained dancers. Future research should explore the clinical utility of proprioceptive tests in professional ballet dancers, and potentially further develop and validate ballet-specific proprioceptive tests.

Keywords

proprioceptive tests

ballet

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Masters

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