Generalized joint hypermobility, scoliosis, patellofemoral pain, and physical abilities in young dancers

Abstract

Background Many young girls with generalized joint hypermobility (GJH) choose to participate in dance because their bodies are suited for this activity. Scoliosis tends to occur often in thin girls, who also are more likely to choose dance. Both anomalies (GJH and scoliosis) may be related to reduced abilities such as diminished strength and insufficient postural balance, with increased risk for musculoskeletal conditions. The main objectives of the present study were to determine the prevalence of dancers with GJH, the prevalence of dancers with scoliosis, and the prevalence of dancers with these two anomalies; and, to determine differences in physical abilities and the presence of patellofemoral pain (PFP) between young female dancers with and without such anomalies. Methods One hundred thirty-two female dancers, aged 12–14 years, were assessed for anthropometric parameters, GJH, scoliosis, knee muscle strength, postural balance, proprioception ability, and PFP. Results GJH was identified in 54 dancers (40.9%) and scoliosis in 38 dancers (28.8%). Significant differences were found in the proportion of dancers with no anomalies (74 dancers, 56.1%) and dancers with both anomalies (34 dancers, 25.8%) (p < .001). Dancers with both anomalies had reduced dynamic postural balance in the anterior direction (p = .023), reduced proprioception ability (p < .001), and weaker knee extensors (p = .036) and flexors (p = .040) compared with dancers with no anomalies. Among dancers with both anomalies, 73.5% suffered bilateral PFP, 17.6% suffered unilateral PFP, and 8.8% had no PFP (p < .001). Conclusions A high prevalence of young girls participating in dance classes had GJH, as the increased joint flexibility probably provides them with some esthetic advantages. The high prevalence of scoliosis found in these young dancers might be attributed to their relatively low body mass, their delayed maturation, and the selection process of dancers. Dancers with both GJH and scoliosis had decreased muscle strength, reduced postural balance, reduced proprioception, with higher risk of PFP. The main clinical implications are the need to reduce the risk of PFP among dancers by developing appropriate strength and stabilizing exercises combined with proprioceptive and postural balance training, to improve the correct alignment of the hyperextended and hypermobile joints, and to improve their supporting muscle strength.

Systematic review of the association between isolated musculoskeletal hypermobility and adolescent idiopathic scoliosis

“…Of the fifteen studies which used a control comparator, or directly correlated musculoskeletal hypermobility and AIS, seven suggested a positive association [21][22][23][24][25][26][27], and eight found no association [28][29][30][31][32], or trends towards a negative association [19,33,34].…”

“…Twelve studies used the Beighton score [21,22,24,25,[29][30][31][32][35][36][37]. Five used the traditional cut-off score of 4/9 [21,[30][31][32]36], and five used a cut-off of 5/9 [22,24,29,35,37].…”

“…Twelve studies used the Beighton score [21,22,24,25,[29][30][31][32][35][36][37]. Five used the traditional cut-off score of 4/9 [21,[30][31][32]36], and five used a cut-off of 5/9 [22,24,29,35,37]. The rationale for using a higher cut-off was justified only by Czaprowski et al [22] as the sample was comprised of females, who have higher rates of hypermobility.…”

“…However, these scores are too low to represent generalised musculoskeletal hypermobility, and individuals with inherited syndromes were not excluded, which could have artificially inflated Beighton scores in those with spinal curvature. A Turkish study also found higher Beighton scores in those with radiologically [38] ** 2* Erkula [25] ** ** 4* Czaprowski [21] ** *** 5* Hasankhani [35] * ** 3* Kobesova [27] * *** 4* Czaprowski [22] **** *** 7* Longworth [32] * * *** 5* Farro-Uceda [29] ** ** 4* Dolphens [30] *** * ** 6* Haller [36] ** * ** 5* Bozkurt [31] ** ** 4* Pratelli [26] *** ** 5* Steinberg [24] * ** 3* diagnosed AIS, and hypermobile individuals (defined as Beighton score > 7/10) had slightly higher ATR measurements (mean 2.31° vs 1.29°, p = 0.039) [25]. Two studies smaller studies (n = 822 and n = 247), both with relatively high prevalence of radiologically diagnosed AIS, (5.2% and 17.8%) found no association with musculoskeletal hypermobility [29,31].…”

Generalized Joint Hypermobility and Anxiety Are Serious Risk Factors for Dysfunctioning in Dance Students: A One-Year Follow-Up Study

“…Factors identified with risk of injury include both physical and psychosocial factors. One of these physical factors is Generalized Joint Hypermobility (GJH), which is highly prevalent with 57% of young high-performing dancers [ 13 , 14 , 15 ]. Although this factor was found to be potentially disabling, GJH is within the dance community often seen as aesthetically beneficial and a sign of talent.…”