PREVENTATIVE FUNCTIONAL SCREENING IN UNIVERSITY DANCERS:
CONSIDERATIONS FOR AN EVIDENCE-BASED TRAINING PROGRAM

A THESIS
Submitted to the Faculty of the School of Graduate Studies
and Research
of
California University of Pennsylvania in partial
fulfillment of the requirements for the degree of
Master of Science

by
Jena A. Hansen-Honeycutt

Research Advisor, Dr. Rebecca Hess
California, Pennsylvania
2013

ii

iii

ACKNOWLEDGEMENTS
First off I would like to thank my parents, thank you
is not enough. The countless opportunities you have
provided me with have allowed me to reach my goals and
dreams. With out you I would not be the person I am today.
Thank you for letting me spread my wings, with knowing I’ll
always have a place in your heart. I love you. Mema, thank
you for always being supportive and proud of my
accomplishments, I love you so much. Positive thinking
truly has helped so much! Thank you to all of my family for
your continued support and encouragement it has meant the
world to me.
I would also like to thank the faculty and staff that
I have met along my journey who have all contributed to my
knowledge. Thank you for the constructive criticism and
support when I needed it. Thank you to my committee members
Dr. Ellen West and Dr. Marc Federico for all of your input
and advice. Thank you especially to Dr. Rebecca Hess for
the guidance, inspiration, enthusiasm, and support. Thank
you to the faculty at California University of Pennsylvania
for all the support and help throughout this year. I would
like to thank the faculty from the University of Idaho, Dr.
Nasypany and Dr. Seegmiller, for the support and
encouragement to always be my best.
To my friends who kept in touch as all of our lives
are changing at light speed. Thank you for the phone calls,
emails, and texts; I look forward to many more years of
friendship. You all have shown me that no matter the
distance I will always have this amazing support team.
Thank you to my friends I made here at Cal I would have not
survived this year with out you. Thank you to all my
friends and family for the memories and laughs I have
shared with you along my journey.
“Focus on the journey, not the destination. Joy is
found not in finishing an activity but in doing it.”
-Greg Anderson

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TABLE OF CONTENTS
Page
SIGNATURE PAGE

. . . . . . . . . . . . . . . ii

ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . iii
TABLE OF CONTENTS
LIST OF TABLES
INTRODUCTION
METHODS

. . . . . . . . . . . . . . iv

. . . . . . . . . . . . . . . vii

. . . . . . . . . . . . . . . . 1

. . . . . . . . . . . . . . . . . . 7

Research Design
Subjects

. . . . . . . . . . . . . . 7

. . . . . . . . . . . . . . . . . 8

Instruments . . . . . . . . . . . . . . . . 9
Procedures

. . . . . . . . . . . . . . . . 11

Hypotheses

. . . . . . . . . . . . . . . . 16

Data Analysis
RESULTS

. . . . . . . . . . . . . . . 16

. . . . . . . . . . . . . . . . . . 18

Demographics . . . . . . . . . . . . . . . . 18
Hypothesis Testing

. . . . . . . . . . . . . 20

Additional Findings . . . . . . . . . . . . . 25
DISCUSSION . . . . . . . . . . . . . . . . . 27
Discussion of Results . . . . . . . . . . . . 27
Conclusions . . . . . . . . . . . . . . . . 36
Recommendations. . . . . . . . . . . . . . . 36
REFERENCES . . . . . . . . . . . . . . . . . 39
APPENDICES . . . . . . . . . . . . . . . . . 43

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APPENDIX A: Review of Literature

. . . . . . . . 44

Pre-Participant Exam’s in Sports . . . . . . . . 45
The Dancer as an Athlete
Dance Training

. . . . . . . . . . 48

. . . . . . . . . . . . . 49

Dancers’ Most Common Injuries

. . . . . . 50

Injury Definition and Surveillance . . . . 52
Injury prevention in Dance . . . . . . . . . 53
Extrinsic and Intrinsic Risk Factors . . . . 54
Components of a Functional Dance Screen . . . 57
Summary

. . . . . . . . . . . . . . . . . 58

APPENDIX B: The Problem

. . . . . . . . . . 60

Statement of the Problem . . . . . . . . . . 61
Definition of Terms . . . . . . . . . . . . 62
Basic Assumptions . . . . . . . . . . . . . 63
Limitations of the Study . . . . . . . . . . 63
Significance of the Study

. . . . . . . . . 63

APPENDIX C: Additional Methods
Informed Consent Form (C1) .

. . . . . . . 66

. . . . . . . . 67

Subject Information (C2 ) . . . . . . . . . . 71
Preventative Screening Form 2004 (C 3) . . . . 73
Screen for Functional Capacity 1997 (C4). . . 76
IRB: California University of
Pennsylvania (C5).

. . . . . . . . . . . . 79

Preventative Screen Excel Raw Data (C6) . . . 81

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Corrective E xercise Pictures
REFERENCES
ABSTRACT

(C7)

. . . . . 85

. . . . . . . . . . . . . . . . 88
. . . . . . . . . . . . . . . . . 92

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LIST OF TABLES

Tables

Title

1

Division II Dancer’s Frequency and Type

Page

of Dance Training . . . . . . . . . . . . 19
2

Profile of Weaknesses in Division II
Dancers . . . . . . . . . . . . . . . . 21

3

Observed Global Issues and Corrective
Exercises . . . . . . . . . . . . . . . 23

4

Amount of Time to Complete the Preventative
Screen on Each Participant . . . . . . . . 25

5

Four Key Corrective Exercises . . . . . . . 33

1

INTRODUCTION

The dancer is involved in a unique sport with specific
artistic and aesthetic demands.1 Due to the physical nature
of dance, a dancer walks the fine line between being an
artist and an athlete.2 Dance is viewed as a form specific
sport, focusing on the style and how aesthetically pleasing
a motion is completed rather than completing a motion to
score a point or goal.1
It is important to understand the physical demands
placed on a dancer to better direct the dance medicine
staff’s efforts in proper care of a dancers injuries and
overall health. Peer et al2 suggest that injury prevention
should be the main focus of the dance medicine team.
Without understanding the demands, strengths, and
limitations placed upon a dancer, an injury prevention
program would be difficult to develop.
Research in dance medicine has been inconsistent; this
has resulted in the lack of consensus and adoption of
universal standards for an injury definition, injury
prevention screen, and an injury reporting system.3 Incident
of injury has been collected on several forms of dance;

2
however, these studies have mainly been self-reported by
the dancer. This leaves the interpretation of an injury up
to the dancer. As a result, even if a dancer is given a
definition of an injury within the context of the research,
it may be unclear of how to rate the severity of the injury
because of difficulty recalling the injury. Ojofetimi et al4
limited collecting information on the injures reported by a
dancer to within the previous 12 months to reduce recall
bias as research has shown that recall accuracy declines
with time.
To effectively reduce dance injuries, a reporting
system that is consistent and systematic is necessary.5 The
clear and consistent definition of an injury is a critical
part of the success of any injury reporting system. There
are two main ways to classify injuries either time-loss or
function-loss. Many non-time lost injuries can be as common
or more common than time lost injuries.6 Weigert et al7
defines an injury as any problem that caused pain and/or
limited participation in a dance activity. Bronner et al8
defines an injury as any physical complaint sustained by a
dancer resulting from performance rehearsal or technique
class. Injury is further delineated in the following ways:
(1) physical complaint injury – able to perform full
activity but feels restricted, (2) medical injury –

3
requires medical attention beyond triage, (3) time loss
injury – results in a dancer being unable to participate in
future performance, rehearsal, or class, and (4) financial
injury – medical injury that results in financial outlay.
In this definition, each injury is also coded by severity,
injury type, location, tissue, activity, and style of dance
and choreography. In this way, this injury definition
addresses the issue of having to code injuries by either
time-loss or function-loss by combining the two ways to
define an injury creating a multi-factorial injury
definition.
To have an effective injury reporting system, there
must be an effective baseline measurement of the dancer.
Objective data collection by use of a functional screen
assessment will contribute to injury prevention efforts by
understanding intrinsic risk factors.9 Other injury
reporting systems used in sports are the National
Collegiate Athletic Association Injury Surveillance System
(NCAAISS) and the National Athletic Injury Reporting System
(NAIRS). Both mainly collect injury incidence and define
injuries upon time-loss, which is not as comprehensive as
the suggested reporting system by the dance medicine
community.5 The NCAAISS and the NAIRS do not have a
recommended functional screen that would help assess

4
intrinsic risk factors and establish baseline results for
athletes prior to injury. An injury surveillance system and
a preventative functional screen can provide information
about where to focus prevention efforts5 and can provide a
thorough examination of intrinsic and extrinsic risk
factors that may influence injury, thus providing a
cornerstone of understanding and planning to conditioning.9
Also used in athletics, the pre-participation exam
(PPE) typically addresses major health concerns or injuries
which may be life-threatening to the athlete.10 The
orthopedic exam often included in the PPE is brief and not
specific enough to address micro strengths and limitations
which may influence training programs or injury prevention
efforts. The dance medicine community has suggested a
functional screen be administered to dancers to better
understand where to focus injury prevention efforts.9 The
functional screen is recommended to use on the specific
population of dancers by Marijeanne Liederbach, PhD, ATC,
PT, CSCS; the screen includes aspects of general fitness,
flexibility, body composition, cardiovascular endurance,
gross muscular strength, range of motion, postural
symmetry, foot biomechanics, and functional movements
specific to dancers.5 When comparing the components included
in the PPE and a functional screen it is clear how much

5
more in-depth the functional screen looks at a dancer, and,
as a result, could provide valuable information to assist
the allied health care professional in providing injury
prevention care.
Ultimately, there is an indefinite amount of possible
functional screens to use. However, the screen published by
Liederbach in 1997 and revised version published in 2004 is
one of the few published functional screens specifically
designed for dancers. Injury prevention screening has
immediate, and potentially long-term benefits for dancers.11
Identifying medical or musculoskeletal conditions that may
predispose the dancer to injury could play a role in
enhancing a dancers movement patterns, leading to more
efficient and effective performance.12 Making sure we
implement an evidence-based training program in a dancers
regime after performing the functional screen and analyzing
the information is paramount. The injury prevention efforts
will allow allied health care professionals to better
understand the unique sport of dance and the injuries
specific to dancers. The purpose of this study was to
identify a functional injury prevention screen that could
be used to provide a framework from which to develop an
evidence-based training program that could be used by

6
practitioners to reduce the potential of injury and enhance
performance of dancers.

7
METHODS

This section includes the following subsections:
research design, subjects, instruments, procedures,
hypotheses, and data analysis in addressing the purpose of
the research.

Research Design

This study used a qualitative research design in which
an evidence-based training program was developed by using
the components of a screen for functional capacity in
dancers. Data was collected on university dancers by using
the Preventative Screening Form (developed by Marijeanne
Liederbach, PhD, ATC, PT, CSCS, Director of Research and
Education at Harkness Center for Dance Injuries). Results
of the dance screen were then organized into an Excel
spreadsheet and used to systematically identify errors to
create a profile. The profile was then used to determine an
appropriate training protocol.

Results should be

applicable to most clinical applications as the training
program is evidence-based in rehabilitation practices used
by certified and licensed clinicians, particularly for the

8
university level dancer participating at similar
demographic institutions.

Subjects

The participants selected for this study were dancers
with 5 years or more of formal dance training, which is
defined as private studio, pre-professional company, and/or
university instruction. The sample of participants was
selected by convenience and experience. All participants
were currently enrolled in a dance class at California
University of Pennsylvania, and/or were classified dance
minors who were actively participating and performing.
There were 13 participants that met this criterion to be
screened for functional capacity. Volunteers were addressed
after approval by California University of Pennsylvania’s
Institutional Review Board. The participants were addressed
during dance classes and/or rehearsals during their
performance season, without the presence of the dance
instructor/choreographer. The dance
instructor/choreographer was the one faculty member that
was asked not to speak with and invite dancers into the
research study. This was done to ensure the instructor/
choreographer did not influence the dancers’ participation.

9
An Informed Consent Form (Appendix C1) and Subject
Information form (Appendix C2) were completed by the
participant prior to the researcher administering each
dance screen.

Instruments

A Subject Information form (Appendix C2) and the
Preventative Screening Form (Appendix C3)(developed and
then revised in 2004 by Marijeanne Liederbach, PhD, ATC,
PT, CSCS, Director of Research and Education at Harkness
Center for Dance Injuries) were utilized in this study to
screen the dancers. The original screen for functional
capacity was published by Liederbach in 19974 (Appendix C4)
was not used. Other devices that were required to
administer the screen were: one measuring tape, a universal
goniometer, Lafayette hand dynamometer, bench step 20
inches for step test, and an inclinometer. The screen
performed on each dancer was timed to create an average of
time needed to perform the screen. The preventative screen
was administered in the order on the form; assessing gross
posture and motion, flexibility/range of motion, manual
muscle testing strength, and lastly functional strength and
skills tests. The Harvard Bench Step Test, which is listed

10
last on the screen, was performed first as a warm-up as
suggested by previous research performed at Harkness. The
detailed outline of the screen can be found in the
procedures section. The majority of the tests procedures
performed on the screen can be found and described in an
orthopedic assessment book.14-

17

The researcher, a certified athletic trainer,
administered the screen and was qualified to perform all
tests and observations within the screen. The components
within the screen were scored by either an average,
positive or negative identification, or scored by bilateral
comparison of range of motion within each test.
Preventative screening instruments are typically
administered by certified and/or licensed health care
professionals such as athletic trainers as standard tests
that assess potential strengths and limitations of an
athlete; in this case, the dancers are considered athletes
but not acknowledged by the NCAA as such. All tests and
observations in the functional dance screen fall within the
scope of practice for a certified athletic trainer, and did
not involve physical exertion beyond a normal dance class.

11
Procedure

After approval of the California University of
Pennsylvania IRB (Appendix C5), the recruitment of
participants began. Volunteers were solicited in the spring
semester during the dance classes and/or rehearsals without
the presence of the dance instructor/choreographer. In this
project, data was collected by following the revised
functional screen, Preventative Screening Form (Appendix
C3). Each dancer was assessed individually by a certified
athletic trainer in the order on the screen, except the
Harvard Bench Step Test was performed first as a warm-up.
There were a number of tests, but combined, they did not
exceed the length of a full dance class, which is typically
60 to 75 minutes, and the dancer could rest at any point
needed.
The first part of the screen for each individual was
the Harvard Bench Step Test assessing for cardiovascular
fitness; the dancer steps up and down on the platform (20
inches) at a rate of 30 steps per minute, for five minutes
or until exhaustion.14 Then assessment of gross posture and
motion of the upper extremities and lower extremities was
evaluated and measured. An active four scapular motion test
was performed; the dancer actively flexed, extended,

12
adducted and abducted the arm at the glenohumeral joint,
looking for abnormal scapular patterns. Iliac crest height
was measured for symmetry bilaterally.15(p623) An inclinometer
(Scoliometer) was then used to asses if the dancer has any
lateral shifting in the spine.16(p107) In the foot, calcaneal
eversion was measured with a goniometer. The “number of
toes” sign was assessed by indicating from the posterior
view how many toes were lateral to the calcaneus. Then the
pes line test(navicular drop test) was performed.
Then, identifying the foot type was observed.15(p865) A
forward bend test, backward bend test, and march test was
performed while the evaluator looked at sacroiliac joint
motion, the full explanation of these tests can be found in
orthopedic evaluation books.15(p626-629,636) General posture was
assessed from the frontal and sagittal plane; identifying
if the dancer had forward head,15(p142) forward
shoulders,16(p223) kyphotic,

16(p223)

flat back,16(p227-228) or a

sway back.16(p227-228) Genu recurvatum was measured with a
goniometer to conclude this section of the screen.15(p735)
Flexibility and range of motion was then assessed in
the lower extremities. The dancer was sitting and was
evaluated to see if they could dome their foot. The dancer
was asked to dome their foot while sitting to display
control over intrinsic foot muscles, sliding the MTP joints

13
back and up wile keeping the toes long. A modified Beighton
test was performed to assess if the dancer was tight or
loose in the thumb to thumb, toe touch,16(p174,102)
lotus(butterfly), and HAD straddle stretches. A dancer’s
Thomas test was performed to assess if the dancer was tight
or loose in the psoas,16(p376) rectus,

16(p376)

ilio tibial band

(ITB),65(p396-397) and sartorius16(p380) stretches. Hamstring
flexibility,16(p384-386) active open chain dorsiflexsion,15(p873)
passive subtalar joint eversion,15(p875-879) and passive great
toe dorsiflexion15(p875-879) were measured supine and/or prone
using a goniometer. Active plantar flexion was observed for
symmetry.15(p873) The dancer was then assessed to see if the
Thomasson sign was present. The Thomasson sign is when the
dancer is asked, while sitting, to actively dorsiflex the
great toe in ankle plantar flexion and dorsiflexion,
testing for a tight flexor hallucis longus. Hip internal
and external range of motion were measured prone using a
goniometer.15(p667)
Manual muscle testing was conducted by using a hand
held dynamometer, which tests maximum strength by having
the dancer contract the muscle groups being assessed for
three seconds, the lower extremity and upper extremity were
both tested. The dancer’s strength was tested twice for
each action and bilaterally. For manual muscle testing the

14
dancer was positioned sitting, prone, or supine. Using the
Kendall textbook for manual muscle testing, terminal
hamstring,

16(pg418)

hip abduction,

16(p426-427)

hip

adduction,16(p426-427) hip flexion,16(p422) and shoulder
abduction16(p315) were assessed.
Lastly, the functional strength and skill tests
section duplicates many motions seen in normal dance
training while allowing the clinician to evaluate movement
patterns and functional biomechanical alignment. A Kendall
supine double strait leg lowering was performed.16(p213)
Standing turnout and disc turnout was measured in degrees,
the difference was then calculated between the two
measurements. A first position relevé was performed by the
dancer, the evaluator looked at the pelvic girdle for
control assessing for a neutral position and if the
calcaneal midline and middle of the patella were aligned
with the 2nd ray. Calcaneal height symmetry was compared
bilaterally. A first position parallel plié was performed
by the dancer specifically looking to see if the plumb line
was aligned with the patella and the first and second toe
tips. A second position progression was performed by the
dancer, the angle of knee was assessed by identifying if it
was aligned over the second toe and a neutral pelvic girdle
position was maintained. Balance was assessed by using

15
Rhomberg test17(p566) and a single-leg strategy test. The
single-leg strategy is the non support leg does not touch
the support leg and the arms are crossed and eyes closed,
assessing to identify where the dancer moves to gain
balance(ankle or hip). Twenty-five heel raises in neutral
parallel first position was then performed; the evaluator
looked for the dancer to maintain full heel height over the
first and second toe without knee flexion. Five single leg
bench step-downs from 20 inches with eyes open, then closed
were assessed. The evaluator looked to see if the dancer
maintained the patella centered over the 2nd ray. The dancer
performed five demi pliés on one foot while the trunk was
pitched forward in the arabesque position. The evaluator
was looking to see if the dancer maintained lower extremity
alignment and balance. Five pushups in a plank position,
which demonstrated trunk control was performed. The dancer
then completed five front planks to five right and left
side planks and was assessed for functional trunk control.
The inverted planks are mainly for breakers and/ or hip-hop
dancers, this test was not performed. Jumping was assessed
by height when the dancer performed a parallel single leg
“sauté” (jump in place) and by distance in the parallel
single leg “jeté”(leap from one place to another. Each

16
participant’s identity remained confidential and was not
included on the functional screen or in the data analysis.

Hypotheses

The following hypotheses were based on previous
research and the researcher’s intuition.
1.

The dance screen will provide a framework from
which to develop an evidence-based training
program that can be used by health care
professionals to reduce the potential of injury
and enhance performance.

2.

The screen for functional capacity will be a time
effective tool to use on dancers when compared to
other screens performed in athletics.

Data Analysis

Data, as tests and observations in the dance screen,
was collected from the Preventative Screening Form
2004(Appendix C3). This data was organized into an Excel
spreadsheet to be able to systematically identify the areas
of strengths and weaknesses as tested by the screen such as
posture, flexibility/ range of motion, strength, and

17
functional strength and skills. The measurements gathered
in the screen created a profile of a Division II university
dancer. The raw data was observed and flagged for
occurrences in the screen where, on average, the dancers
failed to meet the criteria set forth on each individual
special test. When a percentage of the dancers failed to
meet the criteria from the screen tests, those areas were
considered a global issue or error.
Evidence-based exercises that addressed the global
issues and dysfunction within these areas were recommended
based on the profile. To assess time effectiveness, the
average length of time it took to administer the screen was
calculated and compared to similar functional screening
devices used in athletics.

18
RESULTS

The purpose of this study was to identify and use a
functional injury prevention screen to provide a framework
from which to develop an evidence-based training program
that can be used by practitioners to reduce the potential
of injury and enhance the performance of dancers. The
following section contains data collected from the
Preventative Screening Form (Appendix C3) for dancers. The
information collected was used to create a profile of what
a typical Division II dancer might look like. This section
is divided into three subsections: demographics, hypotheses
testing, and additional findings.

Demographics

Participants used in this study (N=13) were volunteer
Division II dancers from California University of
Pennsylvania. The participants were thirteen females
ranging in ages from 18-23, with an average age of 20 years
old (SD=1.66). All participants had at least 5 years of
formal dance training, defined as private studio, preprofessional company, and/or university instruction.
Participants were currently enrolled in a dance class

19
and/or were dance minors who were actively participating
and performing. Dancers were screened during their
performance season. The participants ranged in having 5-19
years of experience with an average of 14 years experience
(SD=4.25). The majority of the participants training
occurred in a private studio setting, with minimal training
at the university level. Only one dancer had limited
experience dancing for a pre-professional company. The
majority of dance training the participants received was in
jazz, ballet, and tap dance. Table 1 lists the types of
dance training.

Table 1. Division II Dancer’s Frequency and Type of Dance
Training
Frequency of
Dancers

Type of Dance Training

12

Jazz

11

Ballet

10
5
4

Tap
Modern
Lyrical

3

Hip-Hop

1
1

Contemporary
Ballroom

20

Hypotheses Testing

Hypothesis 1: The dance screen will provide a framework
from which to develop an evidence-based training program
that can be used by health care professionals to reduce the
potential of injury and enhance performance.

Conclusion: To test the hypothesis, each special or
functional test results were organized into an Excel
spreadsheet as raw data (Appendix C6) which was then
systematically flagged for errors and/or issues. If more
than 45% or 6/13 of the participants failed to meet
“normal” criteria, this data was flagged and used to create
the profile of Division II dancers’ potential weaknesses.
The percentage 45% was determined by the researcher as this
was almost half of the participants displaying errors in
the specific test. The special and functional tests that
45% of the participants failed to meet normal criteria are
listed in Table 2.

21
Table 2. Profile of Weaknesses in Division II Dancers
Test on
Preventative
Screen
Calcaneal
Eversion≥ 4
Dome Foot
Lotus Stretch
ITB
Hamstring
Active open
chain
dorsiflexion
Passive great
toe extension
Thomasson Sign
HER prone
HIR prone
Hamstring MMT
strength
Hip Abductor
MMT strength
Hip Adductor
MMT strength
Hip Adductor
MMT strength
Hip Flexor
MMT strength
First position
relevé
Second position
Second position

Amount of
Participants who
Failed the Test
8/13 R foot
6/13 L foot
8/13 R foot
7/13 L foot
9/13 tight bi

Scored <4°

7/13 tight R
10/13 tight L
8/13 tight R
9/13 tight L
6/13 R foot

Scored <120°

7/13 R great toe
6/13 L great toe
12/13 R great toe
12/13 L great toe
11/13 R hip
11/13 L hip
6/13 R hip
6/13 L hip
Avg 85% bilateral
difference
Avg 10.6 lbs R
10.6 lbs L
Avg 10.2 lbs R
9.8 lbs L
Avg 89% bilateral
difference
Avg 12.2 lbs R
13.4 lbs L
6/13 R
6/13 L
9/13 R leg
6/13 L leg
7/13 L leg

Single leg
strategy
Step down eyes
closed

7/13 R leg
8/13 R knee
9/13 L knee

5 pushups
plank→ side
plank

6/13
13/13 R
13/13 L

Observation

Poor control of intrinsic
foot muscles
Not able to get
appropriate ER at hip
Tight abductors

Scored ≤ 5°
Scored <90°
Tight flexor hallucis
longus
Passive ROM <45°
Passive ROM <45°
More than 10% difference
bilaterally
Normative 14.6-15.5 lbs
Normative 14.8-15.6 lbs
More than 10% difference
bilaterally
Normative 20.2-24.4 lbs
Poor alignment- Calcaneal
midline & mid patella
medial to 2nd ray
Poor alignment – knee
grossly medial to 1st ray
Poor alignment – knee
just medial to 1st ray
Unable to stabilize at
ankle, used hips
Unable to maintain
patella centered over 2nd
ray
Lost trunk control
Lost trunk control

22

After the profile of weaknesses was created from the
preventative screen’s raw data, the profile was
systematically reviewed and flagged for trends in failed
special and functional tests. If the profile identified two
or more failed tests in anatomical areas, the researcher
considered this to be a global issue or error. This screen
mainly examined the trunk and lower extremities; the few
tests screening the upper extremities did not have more
than 45% of participant fail to meet normal. Anatomical
areas presenting errors were divided into trunk, hips, and
lower extremities.

Dividing the global issues into general

anatomical areas allowed the researcher to identify
corrective exercises to address the global issues.
Corrective exercises for the evidence based training
program were developed using the National Academy of Sports
Medicine (NASM) Essentials of Sports Performance Training,14
Harkness Center for Dance Injuries website,18 and functional
dance exercises. Pictures of some of the exercises are
shown in Corrective Exercise Pictures (Appendix C7).
Corrective exercises addressing the global errors and
observed weaknesses are listed in Table 3.

23
Table 3. Observed Global Issues and Corrective Exercises
Anatomical
Areas

Global Issues
Observed

Corrective
Exercises

Trunk

-Poor core
functional stability
& strength

Hips

-Tight hip ER
-Tight hamstrings
-Weak hip ER
-Weak hip flexors
-increase Hamstring
strength and
equalize bilaterally
-Improve hip Abd/Add
strength(gesture leg
strength)

Lower
Extremities

-Poor alignment of
knee and 2nd ray
functionally and
passively
-Tight flexor
hallucis longus/
limited great toe
dorsiflexion
-Poor functional
ankle stability

Planks, pike sit-ups, side
planks with hip abduction,
single leg balance
progressions (working up to
eyes closed and arabesque),
lunges, Swiss ball
progressions (plank, crunch,
roll away), double leg wide
squat control of core
PNF stretch deep hip
ER/hamstrings , standing
single leg hip extension and
flexion and Abduction
(working on gesture leg
control and strength),
single leg balance/ reach
progressions, second
position plié (double leg
wide squat) with correct
alignment of knee and 2nd ray
and pelvic girdle) and
progression to plié to sauté
(polymeric training), selfmyofascial release ITB
Demi-plié parallel with
alignment over 2nd ray,
progress to 1st /2nd position
relevé and plié,
PNF stretch great toe,
single leg balance strength
progressions/ single leg hop
progressions

Hypothesis 2: The screen for functional capacity will be a
time effective tool to use on dancers when compared to
other screens performed in athletics.

24
Conclusion: To test the hypothesis, each participant’s
preventative screen was timed. The timer started when the
practitioner started the preventative screening form and
not during paperwork prior to the screen. It took an
average of 41.5 minutes (SD=7.73) to complete the screen
for each individual. This preventative screen is a
comparable and an effective tool to use on dancers when
compared to other screens performed in athletics. This
screen was identified as effective because of the valuable
data it provided on each dancer. There are many variations
to any screen, thus determining time it takes to complete
PPEs, orthopedic exams, and/or National Academy of Sports
Medicine (NASM) sports performance testing will vary
depending on the clinician. The researcher has had
experience with administering orthopedic exams, NASMs
sports performance testing, and assisting with PPEs. It has
taken the research approximately 15-45 minutes to perform
an orthopedic evaluation, depending on the injury. To
perform NASMs sports performance testing it has taken 30-50
minutes, depending on tests chosen to include. When
assisting with administering a PPE it approximately took
20-30 minutes in a family physicians office. Table 4
illustrates the average time it took the practitioner to
complete the screen for each participant.

25

Table 4. Amount of Time to Complete the Preventative Screen
on Each Participant
Participant #
1
2
3
4
5
6
7
8
9
10
11
12
13
Average
Standard
Deviation

Time in Minutes
55
52
53
45
38
40
45
39
35
32
35
36
35
41.5
7.73

Additional Findings

Many of the special and functional tests on the
preventative screen can identify issues and/or errors that
did not meet the 45% criteria established in this study
that warranted being flagged to include in the profile. For
example, pelvic girdle dysfunction in general was not
included because the occurrence was less than, but close to
45%. Collectively, 7 of 13 participants tested positive for

26
pelvic girdle dysfunction in one of the following tests:
(1) the forward bend, (2) backward bend, and (3) march
test. Of those 7 participants, 5 then failed the single-leg
strategy balance test. Of the 5 participants who had iliac
crest height asymmetry, 3 also tested positive for pelvic
girdle dysfunction. Those 3 dancers who tested positive for
spinal imbalances using the inclinometer also tested
positive for pelvic girdle dysfunction.
It is clear that pelvic girdle instability affected
many other aspects of the participant’s performance on the
screen. Pelvic girdle dysfunction is one item that must be
addressed by a physical therapist and/or certified athletic
trainer before starting corrective exercises.16 The trunk
corrective exercises and the second position plié
progression can assist in developing the core muscles to
potentially prevent this dysfunction form reoccurring.14
Training in biomechanically dysfunctional positions will
allow poor movement patterns to become trained movement
patterns and could increase risk of injury.

27
DISCUSSION

The following discussion is divided into three
sections: discussion of results, conclusions, and
recommendations.

Discussion of Results

This study was designed to identify a functional
screen that would provide a framework to create a profile
of a Division II dancer. A corrective, evidence-based
training program could then be created from the profile and
used by practitioners to potentially reduce risk of injury
and enhance performance. The results showed that the
Preventative Screening Form used for this research could be
used to create a profile of a Division II dancer, and
subsequent corrective exercise program.
The profile identified many weaknesses in these
dancers that may lead to injury. As many dance minors do
not have a skill test or any qualifications before entry
into a dance class or the minor, early training is crucial
for proper alignment and musculoskeletal control.

As most

of the dancers in the current study indicated that most of
their years of experience were provided in private studios,

28
quality of instruction there should be a focus.

Private

studio dance teachers need to have proper education in
dance and movement science, specifically kinesiology,
anatomy and physiology, as well as having the skills to
identify poor alignment in basic dance positions.
Correcting these malalignments at an earlier age could
decrease the amount of limitations presented on later
functional screening, reduce potential injury, and increase
the longevity of the healthy dancer.
The dance medicine community suggests that screening
and thoroughly evaluating dancers for predisposing issues
that may contribute to injuries is critical.2,3,9 A PPE,
which is typically the most basic form of screening used in
athletics, is not designed to address the micro strengths
and weaknesses as well as a functional screen. While there
are many functional screens used in general athletics,
creating and implementing a functional screen that is
adjusted to look at this specialized population can be
overwhelming. The Preventative Screening Form (Appendix C3)
used in this research study is one of many possibilities,
and provided a comprehensive profile of strengths and
weaknesses of the dancers. Incorporating a variety of
special tests and functional skill tests allowed for an indepth profile of each dancer.

29
It was suggested by Potter et al12 that a functional
screen can help detect musculoskeletal conditions that may
predispose dancers to injury. The functional screen used in
this research allowed the researcher to identify weaknesses
in the screened dancers, which can potentially be modified
to assist in injury prevention. The profile created from
the screen identified global errors and malalignments in
the lower extremities and core, with limited tests for
upper extremity. In the lower extremity, the patella was
medially aligned to the second ray in 46% of the
participants in the first position relevé and second
position as opposed to the correct alignment. It is
important to identifying malalignments that can cause
movement impairment syndromes predisposing the dancer to
various injurys.19 The profile identified that 85% of the
dancers had less than 45° of hip external rotation, which
may have led to poor alignment of the knee during first and
second position. If this is seen in other dancers screened,
assessing hip extension and external rotation strength
would be beneficial to understanding the cause of this
issue. Limited hip external rotation indicates that these
dancers are using compensatory strategies to gain motion at
the hip, which may put them at increased risk of knee
injuries.20 By planting their feet at the desired angle of

30
turn out, the functional Q-angle is increased at the knee
and can predispose the dancer to valgus stress and
patellofemoral syndromes.21 It should also be noted that
ballet was not the primary training method, and that more
instruction was provided in private studios where
instructor education and experience in alignment and
functional kinesiology may be limited or absent completely.
Poor functional core stability was also observed; as
100% of the dancers failed to stabilize during 5 plank to
side planks and 46% failed to stabilize during 5 push-ups.
With low back injury incident rates ranging from 8% - 23%
of all injuries dancers are incurring,

14,20,22-26

improving

core stability and restoring functional movement patterns
could potentially reduce the amount of low back injuries.
The functional screen identified an issue that was
seen in some but not all of the dancers and should not be
overlooked by health care practitioners, pelvic girdle
dysfunction. The pelvic girdle is the building block for
efficiently distributing weight, absorbing forces, and
transferring forces to maintain the dancers’ center of mass
over a constantly changing base of support.14 The dancers
who tested positive for pelvic girdle dysfunction in the
forward bend, backward bend, or march test also displayed
other errors on the functional screen. Proper pelvic girdle

31
alignment and function is important to maintaining normal
length-tension relationships, if not dysfunctional movement
patterns may predispose the dancer to hamstring injuries.15
The pelvic girdle works as a unit to produce force and
stabilize isometrically against abnormal compressive,
torsional, and sheer forces.14 If the pelvic girdle is
unable to stabilize properly, this may contribute to low
back pain and potential low back injuries. Without the
pelvic girdle properly functioning the athlete/dancer may
inefficiently transfer forces through their body, decrease
dynamic stability and movement of the femur, and may lead
to predictable patterns of injury.14
As balance is a key requirement to the participate in
dance, dancers exhibiting pelvic girdle dysfunction may
demonstrate less efficient and effective stabilization
strategies on one leg.14 Of the 7 dancers displaying pelvic
girdle dysfunctions, 5 failed the single leg strategy test.
In the 3 participants who had spinal imbalances a pelvic
girdle dysfunction was also seen, weather this is stemming
from the spine or pelvic girdle is unclear. However,
correcting the issue if possible is one way to decrease
risk of injury and minimize training in dysfunctional
biomechanical alignments. Training with proper postural
control decreases the risk of developing muscle imbalances

32
and joint dysfunctions that predispose the dancer to an
array of issues.14 Correcting biomechanical issues or
malalignments is vital to aiding in injury prevention and
performance enhancement.
The profile created from the screen was used in
identifying corrective exercises to address the global
errors seen in this population. The literature suggests
screening can help direct injury prevention efforts,20,26 can
assist in understanding injuries, and how we plan in
regards of dance conditioning.8,9 Implementing a corrective
exercise program after screening dancers is potentially
where health care practitioners will see improvements in
decreasing the amount of global errors. Ideally, creating
an exercise program to aid in correcting all weaknesses
displayed in the profile would have the greatest effect on
reducing risk of injury.

How such training fits into the

already physically active and time demanding training is
uncertain. In general, people can remember 4-5 tasks. Thus,
creating 4-5 functional movements that address correcting a
majority the global issues could prove beneficial due to
time concerns. These functional movements could easily be
adapted into the warm-up of a dance class without
disrupting the culture of dance training. Table 5 lists 4

33
key exercises identified by the researcher as a start to
addressing the global errors.

Table 5.

Four Key Corrective Exercises
Key Corrective Exercises

-Swiss ball exercises (plank, roll away)
-Second position plié (double leg wide squats) (correct
alignment of knee, 2nd ray, and pelvic girdle)
(progression to plié hold and plié to sauté) (progress
from stability, strength and then polymeric training)
-Standing single leg hip extension and flexion (working
on gesture leg control and strength) (control pelvic
girdle)
-Single leg balance/ reach (strength/ single leg hop
progressions)

The profile displayed many issues that could be
addressed by several individual corrective exercises. The
key corrective exercises were identified by if the exercise
could address several global issues. The specific
progressions were left to the health care professional
implementing the corrective exercises, as each dancer will
progress at a different pace. Many dancers failed to have
functional core stability or strength, the Swiss ball
exercises were chosen to develop stability in the core and
pelvic girdle.14,18 A second position plié with focus on
correct alignment was chosen to help develop functional
core, hip flexors, and hip external rotators strength.
Standing single leg hip extension/ flexion exercises were
chosen to help develop core, pelvic girdle, hip extension/

34
flexion strength during functional movements as well as
improve balance on the support leg.18 A single-leg balance/
reach progression was chosen to develop neuromuscular
efficiency in the lower extremity as well as improve core
and pelvic girdle strength during functional movements.14,18
Performing only these corrective exercises daily could
start to address some of the global issues seen in the
dancers.
There are many exercises that could have been included
into the corrective exercise program. The researcher
suggested the exercises based on the global issue observed
and known exercises that would target the issues.
Understanding that the heath care practitioner would need
to utilize their knowledge of progressions (stabilization,
strength, power) to properly implement the training program
is important. The focus of every exercise should be correct
form and alignment, if needed the exercise should be
modified to allow for this. Strength training is often
negatively viewed by dancers because of specific aesthetic
requirements. However, no evidence has indicated that
strength training would negatively affect flexibility or
aesthetic requirements.1,27 Tailoring the corrective exercise
program to these unique athletes while addressing the

35
global errors was the main focus when suggesting the
exercises listed.
Injury prevention is a multifaceted concept it
encompasses addressing two main factors, extrinsic and
intrinsic risk factors.4 Injury prevention can be an
overwhelming and difficult task, but by addressing the
factors we can control this one way we as the dance
medicine community can meet the recommendations of having
our main focus on injury prevention.11 If we approach injury
prevention by implementing appropriate PPE for a dancer by
implementing a functional screen, creating a profile to
identify global issues, and then implementing 4-5
corrective functional movements to address intrinsic risk
factors, we may be able to significantly reduce the risk of
injury. Although controlling and limiting extrinsic risk
factors is a task we may or may not be able to change,
addressing one of the main factors will be a solid start to
addressing this difficult task. Other implications,
secondary to the research purpose, point to dance training
which may not have addressed the noted dysfunctions
exhibited in approximately half of the dancers. Focus on
physical training, corrective exercise, and the use of
certified health care and/or fitness professionals in

36
private dance studios may aid in reducing such dysfunctions
and enhance performance overall.

Conclusions

Using the functional screen was an effective tool in
identifying strengths and limitations in the dancers.
Global errors can be taken from the screen’s test results
with corrective training exercises developed for individual
dancers that could potentially reduce the risk of injury if
properly treated by a physical therapist/ certified
athletic trainer. Identifying 4-5 exercises that
functionally target many of the global issues would be
ideal for health care practitioners and allow for ease when
suggesting application to the dance instructor or dancer,
and could be used with any dancer with similar demographics
and profile.

Recommendations

This study established a profile of strengths and
weaknesses of Division II dancers at one university.
Similar studies should expand on creating profiles of
dancers at other universities with similar or different

37
demographics. Understanding the differences among
university, youth, and professional dancers could assist in
developing what injury prevention efforts need to be
implemented at each level. This would allow the researcher
to identify if the global issues found in these university
Division II dancers are global issues of dancers across
various levels of dance and/ or experience.
Additionally, future research should include a more
in-depth injury and training history. Ideally, using the
data collected from the functional screen with an injury
surveillance system would provide the most comprehensive
profile of a dancer. The dance medicine and science
community is currently in the process of addressing this
issue.5 Private studios might benefit form in-studio
services with a certified health care professional in using
screens earlier in a dancer’s career and implementing
subsequent corrective exercises.
Implementing the corrective training program and rescreening the dancers is recommended to see if the training
program reduced the global errors. This may provide
confirmation that the dance medicine community is headed in
the correct direction for injury prevention efforts. The
functional screen showed to provide valuable information on
this population. After the data has been collected,

38
implementing the corrective training program could be the
most important step to reducing risk of injury and
enhancing performance in dancers.
Currently there is no standard for time needed to
perform screens. In future research determining if the
functional screen used in this study is a time-effective
tool when compared to another form of a functional screen
would be helpful. This inconsistency of non-uniform
screening has been well documented in the sports medicine
and dance medicine community.10,28

39
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Peer K, Dubois K. Preventing dance injuries, part I:
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Liederbach M. Screening for functional capacity in
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1997;1(3):93-106. Available from: CINAHL with Full
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Ojofeitimi S, Bronner S, Woo H. Injury incidence in
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Liederbach M, Richardson M. The importance of
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Powell J, Dompier T. Analysis of injury rates and
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Weigert B, Erickson M. Incidence of injuries in female
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Bronner S, Ojofeitimi S, Mayers L. Comprehensive
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Allen N, Wyon M. Dance medicine: Artist or
athlete?. Sportex medicine [serial online].
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Wingfield K, Matheson G, Meeuwisse W. Preparticipation
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with Full Text, Ipswich, MA. Accessed November 6,
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Peer K, Dubois K. Preventing injuries to dancers, part
2: Keeping dancers on their feet. Athl Ther Today.
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Potter K, Galbraith G, Baas J. Screening for improved
dance function. IADMS Bulletin for Teachers.
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Wilson M, Deckert J. A screening program for dancers
administered by dancers. J Dance Med Sci. August
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Clark MA, Lucett SC. NASM Essentials of sports
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Williams & Wilkins. 2010: chapter 3 & 6.

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Magee DJ. Orthopedic physical assessment. 5th ed. St.
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Kendall FP, McCreary EK, Procance PG, et al. Muscles
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Baltimore, MD. Lippincott Williams & Wilkins. 2005:
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Starkey C, Johnson G. Evaluation of orthopedic and
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Liederbach M. Functional Training Exercises. Harkness
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Liederbach M. Perspectives on dance science
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Garrick J, Requa R. Ballet injuries: An analysis of
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Brownstein B, Bronner S. Functional movement:
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sports physical therapy. New York: Churchhill
Livingstone Inc., 1997. Pg.278

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Solomon R, Micheli L. Technique as a consideration in
modern dance injuries. / Technique de Modern Danse et
risque lesionnel. Phys Sportsmed. August
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Full Text, Ipswich, MA. Accessed November 6, 2012.

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Quirk R. Injuries in classical ballet. Aust Fam
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Liederbach M. Performance demands of ballet: A general
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Evans RW, Evans RI, Carjaval S, Perry S.
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Evans RW, Evans RI, Carjaval S. Survey of injuries
among west end performers. J Occup Environ Med.
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Koutedakis Y, Stavropoulos-Kalinoglou A, Metsios G.
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Solomon R, Solomon J. Abstracts from the 16th annual
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43

APPENDICES

44

APPENDIX A
Review of Literature

45
REVIEW OF LITERATURE

In the performing arts, dancers are known to have
injury incidence across all forms of dance. With certified
athletic trainers working in several dance settings, it is
important to understand the needs of this special
population.1 Athletic trainers specialize in the prevention,
diagnosis, treatment and rehabilitation of injuries and
illnesses in physically active people.1 If the allied health
care professions could create a standardized screening tool
that is used to asses strengths and limitations of dancers,
a decrease in injury rates could potentially be observed.
Analyzing the various injuries that occur in dance and what
screening tools can prevent these injuries will help keep
dancers healthier and injury free. The purpose of this
review is to enlighten the reader on the importance of the
current Pre- Participation Exams, understanding the dancer
as an athlete, and potential functional screening tools
tailored to dancers.

Pre-Participation Exams in Sports
A typical pre-participation exams (PPE) required for
participation in other sports is not targeted to assess
micro-strengths and limitations for injury performance,

46
rather it is focused on medical history.2 The purpose of the
PPE is to screen for any major health or cardiovascular
abnormalities which may prevent the athlete from any preexisting condition that may be life-threatening. There is a
brief orthopedic section asking about previous injuries to
see if there are any prior injuries that would prevent them
from safe participation in sports.2 There is limited
research regarding the best practices for a PPE, even
though the PPE is a nationwide requirement for most sport
organizations for participation yet there is no standard
protocol.2 The screen for any pre-existing cardiovascular
conditions that may be life-threatening has stayed fairly
consistent in asking about family and personal history,
progressing to an electrocardiogram (ECG) or stress test if
the athlete has a family history or abnormal heart beat.
However, the American Heart Association (AHA) has not
recommended mass ECG and stress testing as conflicting
evidence has been reported on the sensitivity of these
tests detecting life-threatening cardiovascular conditions,
specifically sudden cardiac arrest. There is no functional
screen required to be included in a PPE, yet there are many
functional screens being utilized across the country.
There has been little information reported on PPEs
given to dancers prior to participating. Dancers do need a

47
PPE for participation mainly focusing on a general health
history and brief orthopedic exam; however, the orthopedic
exam and functional screen need to be properly adjusted to
look at this specialized population more in-depth. The PPEs
are the most widely used form for injury prevention, but
the orthopedic exam is not specific enough to address micro
musculoskeletal limitations that may put the dancer at risk
for injury which suggests the need for a functional screen.
Depending on the type of program the dancers are associated
with, they may or may not have the opportunity to receive
an orthopedic exam or a functional screen prior to
participating in the dance class. The need for a
comprehensive functional screen and an injury surveillance
system in dance has been well documented; still the
possible methods for creating and implementing each are
unlimited.3 In 2004, the International Association for Dance
Medicine and Science (IADMS) research committee began a
project to adopt a uniform testing and reporting method.
The first step this committee saw necessary was to analyze
screening form items and methods currently used to screen
dancers they collected 68 forms from 13 countries. This
process of identifying important components of the
functional screen currently used by allied health care
professionals is potentially a step towards adopting a

48
uniform functional screen. The screening process can be
very time consuming, yet the study done by Allen et al4
showed that the screen assists in the ability to predict
and prevent injuries in dance company members.

The Dancer as an Athlete
An abundance of information has been collected on
incidence of injuries in dancers, which have indicated that
even though dance is not a competitive sport, the physical
demands they endure are as potentially traumatic as those
other athletes’ face.5 Nicholas et al6 assessed 61 sports
and activities in three categories: neuromuscular,
psychometric, and environmental factors. Ballet ranked
second behind football as the most demanding of all sports
and activities.6 The article received criticism after it was
published because after 1975 the ability to objectively
measure motor skills between sports advanced tremendously.
More importantly, Marijeanne Liederbach suggests dancers
are unique athletes.5 In each movement a dancer performs,
athleticism and art is combined. In most traditional team
sports, how an athlete performs a motion does not matter as
long as the goal or point is scored. While we see formspecific individual sports such as diving, figure skating,
and gymnastics, in dance, every motion adds to the

49
performance and how the dancer executes each movement is
just as important as the motion. This creates a fine line
that a dancer balances which is not seen in many other
sports. A dancer requires specific training that does not
interfere with the artistic and aesthetic requirements.7

Dance Training

Dancers have specific aesthetic requirements that have
limited their training in the past. Recent studies have
showed that certain strength and cardiovascular training
will reduce risk of injuries and may not interfere with the
aesthetic appearance of a dancer.7,8 Recent data is showing
that supplementary aerobic activity and muscular training
may reduce injuries in dance.8 There is no evidence
indicating that strength training negatively affects
flexibility, which often may be a reason dancers avoid
strength training.8 In a 12-week supplementary strength
training program for hamstrings and quadriceps, authors
found the program beneficial to professional ballerinas;
the program did not alter selected thigh aesthetic
components which is often a main concern.7 Dancers with
lower thigh muscle power outputs were found to be at an
increased risk of lower extremity injuries, including ankle

50
injuries.9 An increase in muscular strength may increase a
career in dance. More research is needed to objectively to
determine if strength training would actually increase the
longevity of a dancer’s career as previous research
indicates.9 Understanding what type of physical training
will aid a dancer in having a strong and stable base for
all dance movements without distracting from their desired
aesthetic appearance can assist in providing injury
prevention care.

Dancers’ Most Common Injuries

There are several different types of dance such as
ballet, modern, jazz, tap, Latin, hip-hop, and theatre
dance (Broadway). The majority of studies regarding injury
incidence have collected information specific to the ballet
form of dance. Much of the information collected on injury
incidence across all forms of dance is of self-reported
injuries. This leaves the definition of an injury up for
interpretation by the researcher or dancer, and creates
conflicting result across the research. In 2006, there was
still no consensus in the dance medicine community on a
definition of injury.10 In 2007, IADMS identified two main

51
injury definitions: (1) by time lost from activity, or (2)
by function lost.11
In self-reported studies of injury incidence, injuries
were categorized depending on the anatomical location. Some
studies separate foot and ankle, whereas others combine
these as one area of injury. The majority of all injuries
that dancers experience across all forms of dance are in
the low back or lower extremity. In ballet, modern, and
Broadway forms of dance, foot and ankle injury incidence
ranges from 22.5% to 48.8% of all the injuries dancers are
experiencing.12-18 Low back injury incidence ranges from 8%
to 23% of all the injuries dancers experience.12-18 Hip-Hop
dancers were reporting injury rates that were higher than
other forms of dance but similar to gymnastics.19 Hip-Hop
dancers spent a minimal amount of time in a warm-up and
cool down, with 33% of the dancers admittedly did not warmup prior to dancing.

This has been a possible explanation

for the higher rate of injuries.20 Most injury research has
been done on professional mature dancers with a reported
60-90% of dancers needing to stop performing for extended
periods of time due to overuse injuries.21 Dancers, during
their pubertal growth spurt, are at a higher risk of
injury.21 More research is needed on younger dancers and
injury types.21

52

Injury Definition and Surveillance

The wide range of how injuries are defined and
reported has generated some recommendation for the dance
medicine community to adopt uniform testing and reporting
methods.3 The reporting method was encouraged to be used by
health care professionals such as certified athletic
trainers and licensed physical therapists that are working
with dance schools or companies. There are two systems used
in collegiate sports, the National Collegiate Athletic
Association (NCAA) has an Injury Surveillance System (ISS)
and the National Athletic Injury Reporting System (NAIRS),
and one in professional dancers, International Performing
Arts Injury Reporting System (IPAIRS). However, both
systems developed for collegiate sports only collect injury
incidence and are not near as extensive as the one
suggested to implement by the dance medicine community.10
These systems base their injury definition on time loss and
not on function loss, although the IPAIRS does allow
grading of a dancers function by using a task grid.
This reporting system would create a standard of what
is defined as an injury in the dance sports medicine realm.
The comprehensive reporting system would be able to account

53
for injury occurrence, intrinsic risk factors, and
extrinsic risk factors.22 More specifically, it would also
allow an understanding of what the injury was, specific
anatomical location, severity of the injury, prevalence of
the injury across dancers, injury outcome, what type of
injuries dancers are incurring versus what they perceive
their injury to be, and how to provide better injury
prevention care.10,11

Injury Prevention in Dance
Injury prevention is a multifaceted concept that
requires addressing this topic from two main directions,
evaluating the extrinsic factors and intrinsic factors that
may increase the risk of a dancer sustaining an injury.19
The extrinsic risk factors are items that we as health care
professionals may or may not be able to modify, but we must
take into account when making recommendations to a dancer’s
environment to aid in injury prevention. Intrinsic risk
factors are items that we can modify usually by altering a
dancers training program and over time we may be able to
assist in injury prevention. Potter et al23 also suggests
that a functional screen which would assess intrinsic risk
factors can help detect medical or musculoskeletal

54
conditions that may predispose dancers to injury and/or
illness during their season.

Extrinsic and Intrinsic Risk Factors
It is important to recognize extrinsic risk factors
that are specific to dancers; the dance discipline, shoe,
floor surface, muscle imbalances, and training regimen.15
The type of dance discipline has been shown to vary the
risk and type of injury. Dunn and Graham24 suggest classical
dancers maintain a rigid torso, and that modern dancers
perform more ballistic trunk movements creating the
potential for more back injuries. Another example is modern
dancers mainly dance barefoot, which predisposes these
dancers to unique biomechanical factors because of the type
of dance they are studying.22 The shoe, for most athletes,
provides stabilization, absorbs and returns forces, and
protects the skin from bruising; in dance they are often
barefoot or in pointe shoes which can also distort ground
reaction forces.5 The floor is also a consideration, ideally
it would be constructed from sprung wood. However, the
floor is often sloped, splintering, or made from cement
base.5 Many dancers, particularly college dancers, are
exposed to different surfaces in their training. This can
often confuse a dancer’s estimation of the spring in the

55
floor which could potentially cause dynamic overload
throughout the kinetic chain.24
Identifying muscle imbalances may help identify
relative weakness or limited ranges of motion the dancer
may have developed from compensating movement patterns.24
All of these extrinsic risk factors play an important role
when considering changes to create a safer environment for
the dancer to dance in. We may be able to or not be able to
implement changes depending on the resources available.
Intrinsic risk factors specific to dancers are age,
anatomical structures, and body mass index.22 Age and
maturity level of a dancer helps determine appropriate
intensities of class and rehearsals for the stage of the
dancer’s body.25 The knees of younger dancers tend to be at
higher risk than older more trained dancers because of
compensating strategies used to gain external rotation of
the hip.18 The anatomical abnormalities of structures in
each dancer can cause abnormal weight-bearing loads; this
can lead to primary and secondary kinetic-chain
dysfunctions which are both common in dancers.22 Research
suggests that underlying injuries are subtle malalignments
or anatomical abnormalities which cause movement impairment
syndromes.26 Lastly, a dancer’s body mass index with
excessive fat mass and decreased lean muscle tissue or a

56
dancer using nutritional deficiencies as an attempt to
maintain leanness; both may be predisposing causes to
injuries.22 These intrinsic risk factors play an important
role in limiting or advancing the training programs that
will allow the dancer to dance at the appropriate intensity
level based on their body.
Several studies’ recommendations indicated that one of
the best ways to detect potential risk factors and reveal
existing injuries is through functional screening.10,15,21,25
Since it is recommended that screening and injury
prevention be the main focus of the dance medicine team,25
screening could identify the intrinsic risk factors that
possibly could influence our understanding of injuries and
planning in regards of the dancers conditions.4,10 Screening
was one element of a comprehensive program that showed to
reduce injury rates in both a ballet and a modern dance
company.12,26,27 Dancers with previous injuries are more
likely to sustain an injury than those who have not had a
prior injury.23 Screening all dancers for predisposing
conditions that contribute to injuries is a critical part
in injury prevention10 and helps direct injury prevention
efforts.17,18

57
Components of a Functional Dance Screen
The functional screening tool should include
components such as posture, fitness, orthopedic assessment,
strength, flexibility, range of motion, biomechanics, and
functional capacity activities relative to the unique
training requirements of the specific sport, in this
instance, dance.29 In data collection on injuries in dance
it is important to collect lateral bias information. We
might have a better understanding on injuries if laterality
is assessed during a functional screen and after injuries
incur.29 If a dancer is not able to complete the screen,
then the clinician should look for possible proprioceptive
deficits, muscular weakness or tightness, or a learned
movement behavior that is not optimal for overall neutral
human mechanics.26 The screen for functional capacity for
dancers created by Liederbach is currently one of the few
published injury prevention screening tools specifically
for dancers. It is important that the functional screen is
used to detect medical or musculoskeletal conditions that
may predispose dancers to injury and help them become
better dancers and not as a tool for judgment.23 This can
help dancers educate themselves on the findings and work
with physical therapists or athletic trainers to develop
realistic strategies to address the areas they can

58
improve.23 Using a functional screen in dance can have
immediate and potentially long term benefits for dancers.23
Students in a dance kinesiology class were trained to
perform a functional screen on their peers to promote
wellness and education within the dance department. The
screen assessed alignment (static and dynamic), functional
symmetry, range of motion (passive and active), range of
motion bilaterally, strength, shoulder girdle mobility, and
femoral external rotation.31 An exercise prescription phase
was implemented in this study, but it was limited to four
weeks. Because of this, the study suggested dancers were
limited to only being able to enhance their understanding
and awareness of their bodies. Wilson et al31 recommended
that screening in dance has the potential to become a vital
element in education and informing dancers, it is important
though that this screen is not used for evaluation or
placement with in a dance program.31

Summary

Often the athleticism required of dancers is
underappreciated, and the training dancers under-go causes
common injuries and injuries specific to dancers.22 The
differences in types of dance also cause differences in

59
injuries.22 It has been suggested that injury prevention
should be the main focus of the dance medicine team,22 a
functional screen is an viable way to start injury
prevention efforts. A functional screen should include an
orthopedic assessment, strength, flexibility,
cardiovascular endurance, and functional capacity relative
to the unique training requirements.29 In general athletics,
there are many screens that an athlete is put through how
we use this information is probably one of the most
important aspects of performing a functional screen. A
functional screen specific to dancers that will identify
micro strengths and weaknesses to aid in injury prevention
efforts,2 this information would be very valuable to the
dance medicine community. It would be most beneficial that
this functional screen is performed on all dancers to
identify predisposing conditions that might contribute to
injures.27
Using a screen with a comprehensive injury
surveillance system has the potential in the future to test
theories10 and help identify intrinsic and extrinsic risk
factors. With much less information available on the
frequency and type of injuries particularly in dancers in
college and university programs28 a functional screen would
help in our understanding of these unique athletes.

60

APPENDIX B
The Problem

61
STATEMENT OF THE PROBLEM
The purpose of the study was to use a functional
screen to create a profile for a Division II university
dancer. Once the profile is created, an evidence-based
training program was developed to help correct the
limitations shown by the screen. It is important to create
this profile and provide an evidence-based training program
as dance training often causes injuries seen in other
sports as well as those unique to dancers.21 Understanding
intrinsic risk factors is a critical step to reducing
injuries in dancers and can help in identifying any
predisposing conditions that might contribute to injuries.22
Additionally, the information collected by a functional
screen, identifying typical strengths and weaknesses, may
aid in injury prevention efforts. This can be used to
better understand injury frequency and type of injury in a
Division II University dancer, which there is much less
information overall in college and university dancers.26 The
ultimate goal of the functional screen and an evidencebased training program is being able to decrease the amount
of injuries dancers that fit this profile may incur.

62
Definitions of Terms
The following definitions of terms were defined for
this study:
1)

Extrinsic risk factors - factors relating to type of

work, exposure or duration of workload, equipment and
environmental conditions.4
2)

Formal dance training - private studio, pre-

professional company, and/or university instruction.
3)

Dance medicine team - health professionals, such as

but not limited to certified/ licensed athletic trainer,
physical therapist, orthopedic surgeon, dietitian,
osteopathic doctor, general physician
4)

Functional screen - A tool that is used to identify

specific physical strengths, weaknesses, and biomechanical
normalities or abnormalities of the dancer.
5)

Injury - any physical complaint sustained by a dancer

resulting from performance rehearsal or technique class.
Injury is further delineated in the following ways : (1)
physical complaint injury, (2) medical injury, (3) time
loss injury, and (4) financial injury. Coding by severity,
injury type, location, tissue, activity, and style of dance
and choreography is also included.10
6)

Intrinsic risk factors - factors relating to specific

individual physical characteristics.4

63

Basic Assumptions
The following were basic assumptions of this study:
1)

The functional screen is valid and reliable in

identifying strengths and limitations in University
dancers.
2)

The subjects will be honest when they complete their

demographic sheets regarding injury history and will
perform to the best of their ability during the functional
screen.

Limitations of the Study
The following were possible limitations of the study:
1)

A small sample size of dancers with the dance

experience and training needed to be participants in our
study.
2)

Results from the profile provided by the preventative

screening form may be limited to dancers defined in this
study with similar demographics.

Significance of the Study
The results of the functional screen are an important
component of the injury prevention process. The functional
screen created by Marijeanne Liederbach has basic fitness

64
aspects and an in depth functional assessment, looking
beyond a basic orthopedic exam, while keeping in mind this
specific and unique population. Screening for functional
safety is difficult and time consuming, and in dance
because its essence as an art makes this task more
difficult.28 Another aspect that adds to the difficulty of
screening is the lack of objective and precisely measured
ergonomic assessments of the demands of dance.28 This
functional screen will provide a profile of strengths and
weaknesses that may contribute to injuries in a Division II
university dancer; this is beneficial because there is
limited information on this level of a dancer.26 Developing
an evidence-based training program to address these
dancers’ specific strengths and weaknesses, will increase
the dancers, included in this study, body awareness and
allow them to work on areas that may put them at an
increased risk for injuries by using the best possible
exercise for addressing each issue. It is important to
treat the body as a whole when implementing a preventative/
corrective evidence-based training program and make sure we
are effectively using the information provided by the
screen. The profile that the functional screen will create
and the evidence based training program are two very
important aspects of preventing dance injuries while

65
providing quality information about where to focus injury
prevention efforts.28

66

APPENDIX C
Additional Methods

67

APPENDIX C1
Informed Consent Form

68

Informed Consent Form
1. Jena Hansen-Honeycutt, LAT, ATC, who is a Graduate Athletic Training Student, at
California University of Pennsylvania, has requested my participation in a research study
at California University of Pennsylvania. The title of the research is A Preventative
Functional Screening in University Dancers: Considerations for an Evidence-Based
Training Program.
2. I have been informed that the purpose of this study is to create a profile of a university
dancer by using a functional screen that assesses anatomical and functional movement
specifically for dancers. I understand that I must be 18 years of age or older to participate.
I understand that I have been asked to participate because I have at least 5 years of formal
dance training, which is defined as private studio, pre-professional company, and/or
university instruction. I am also currently enrolled in a dance class at California
University of Pennsylvania and/or I am a dance minors who is actively participating and
performing.
3. I have been invited to participate in this research project. My participation is voluntary
and I can choose to discontinue my participation at any time without penalty or loss of
benefits. My participation will involve an completing a functional dance screen which
includes an orthopedic assessment, flexibility testing, strength testing, cardiovascular
fitness test, and a functional dance assessment. All of the functional tests are similar to
activities required of me during an actual dance class. Completing the screen is expected
to last about an hour which is similar to the length of a dance class. The tests I will be
completing will be explained and shown to me before I will perform them by the
researcher, Jena Hansen-Honeycutt, a certified athletic trainer, who will administer all
tests. I understand that at any time I may take a break if needed.
4. I understand there are foreseeable risks or discomforts to me if I agree to participate in
the study. With participation in a research program such as this there is always the
potential for unforeseeable risks as well. These tests do impose some risk for the dancer
such as an minor soreness and / or injury. To minimize the risk a certified athletic trainer,
Jena Hansen-Honeycutt, will be present and the task will be explained and demonstrated
prior to the dancer completing the task. This risk is less than a dancer’s typical training
during a typical dance class or rehearsal. During some of the test the dancer will be
spotted if the test tests for balance, or if the dancer asks to be spotted.
5. I understand that, in case of injury, I can expect to receive treatment or care in Hamer
Hall’s Athletic Training Facility. This treatment will be provided by the researcher, Jena
Hansen-Honeycutt, LAT, ATC, under the supervision of the CalU athletic training
faculty, all of which can administer emergency care. Additional services needed for

69
prolonged care will be referred to the attending staff at the Downey Garofola Health
Services located on campus.
6. There are no feasible alternative procedures available for this study.
7. I understand that the possible benefits of my participation in the research are to better
understand my personal strengths and limitations as a dancer. I will also be taught
optional exercises to prevent injury and correct my strengths and limitations based upon
the profile created from the screen. My participation in this study will also help allied
health care practitioners understand a Division II University dancer; and may provide
valuable information on reducing injuries and enhancing performance.
8. I understand that the results of the research study may be published but my name or
identity will not be revealed. Only aggregate data will be reported. In order to maintain
confidentially of my records, Jena Hansen-Honeycutt will maintain all documents in a
secure location on campus and password protect all electronic files so that only the
student researcher and research advisor can access the data. Each subject will be given a
specific subject number to represent his or her name so as to protect the anonymity of
each subject.
9. I have been informed that I will not be compensated for my participation.
10. I have been informed that any questions I have concerning the research study or my
participation in it, before or after my consent, will be answered by:
Jena Hansen-Honeycutt, LAT, ATC
STUDENT/PRIMARY RESEARCHER
Han8049@calu.edu
360-303-6430
Rebecca Hess, PhD
RESEARCH ADVISOR
Hess_ra@calu.edu
724-938-4356
11. I understand that written responses may be used in quotations for publication but my
identity will remain anonymous.
12. I have read the above information and am electing to participate in this study. The
nature, demands, risks, and benefits of the project have been explained to me. I
knowingly assume the risks involved, and understand that I may withdraw my consent
and discontinue participation at any time without penalty or loss of benefit to myself. In
signing this consent form, I am not waiving any legal claims, rights, or remedies. A copy
of this consent form will be given to me upon request.
13. This study has been approved (#12-025) by the California University of Pennsylvania
Institutional Review Board.

70

14. The IRB approval dates for this project are from: 3/5/2013 to 3/4/2014.

Subject's signature:___________________________________
Date:____________________
Witness signature:___________________________________
Date:____________________

71

APPENDIX C2
Subject Information

72
Subject #:__________
Age:________
Dance Class Enrolled in at University:____________________
Dance Experience:
Type:_________________ Setting:__________________ Yrs:_____
Type:_________________ Setting:__________________ Yrs:_____
Type:_________________ Setting:__________________ Yrs:_____
Previous Injuries:
Non- Dance related injuries:
Injury:____________________________________________________
Cause of injury: Trauma/Overuse
Treatment:_________________________________ Year:__________
Dance related injury:
Injury:____________________________________________________
Cause of Injury:

Trauma/Overuse

Treatment:_________________________________ Year:__________
Did it occur while dancing or because of dance?____________
Were you still able to dance?______________________________
Dance related injury:
Injury:____________________________________________________
Cause of Injury:

Trauma/Overuse

Treatment:_________________________________ Year:__________
Did it occur while dancing or because of dance?____________
Were you still able to dance?______________________________

73

APPENDIX C3
Preventative Screening Form 2004

74

75

76

APPENDIX C4
Functional Screen 1997

77

78

79

APPENDIX C5
Institutional Review Board –
California University of Pennsylvania

80
Institutional Review Board
California University of Pennsylvania
Morgan Hall, Room 310
250 University Avenue
California, PA 15419
instreviewboard@calu.edu
Robert Skwarecki, Ph.D., CCC-SLP,Chair

Dear Ms. Hansen-Honeycutt:
Please consider this email as official notification that your
proposal titled "Preventative Functional Screening in University Dancers:
Considerations for an Evidence-Based Training Program” (Proposal #12025) has been approved by the California University of Pennsylvania
Institutional Review Board as amended.

The effective date of the approval is 3-5-2013 and the expiration
date is 3-4-2014. These dates must appear on the consent form .
Please note that Federal Policy requires that you notify the IRB promptly
regarding any of the following:

(1) Any additions or changes in procedures you might wish
for your study (additions or changes must be approved by
the IRB before they are implemented)
(2) Any events that affect the safety or well-being of subjects
(3) Any modifications of your study or other responses that
are necessitated by any events reported in (2).
(4) To continue your research beyond the approval expiration
date of 3-4-2014 you must file additional information to be
considered for continuing review. Please
contact instreviewboard@calu.edu
Please notify the Board when data collection is complete.
Regards,
Robert Skwarecki, Ph.D., CCC-SLP
Chair, Institutional Review Board

81

APPENDIX C6
Preventative Screening Form
Excel spreadsheet of Raw Data

82
Special/Functional
Tests
Time

Part.
1

Part.
2

Part.
3

Part.
4

Part.
5

Part.
6

Part.
7

Part.
8

Part.
9

Part.
10

Part.
11

Part.
12

Part.
13

55

52

53

45

38

40

45

39

35

32

35

36

35

Scapular Motion Abd

N

N

N

N

YR

N

N

N

N

N

N

N

N

Iliac Crest Sym

Y

Y
10R/0
/0

Y

Y

Y

Y

N

Y

Y

N

0

0

0

0

0

0

N
0/0/4
R

N

0

N
3R/0/
0

0

0

0

Y

N

N

N

N

N

N

Y

Y

Y

Y

N

N

N

Y

Y

Y

N

N

N

Y

N

Y

Y

N

Y

2

1

2

3

2

1

3

3

3

2

3

2

2

Scoliometer
Calcaneal
EversionR≥4
Calcaneal
EversionL≥4
"Number of Toes" R
"Number of Toes" L

2

3

2

3

1

1

2

2

2

2

2

1

2

Pes Line R

↓

=

=

↓

=

↓

↓

↓

↓

=

↓

↓

↑

Pes Line L

↓

↓

=

↓

↑

↓

↓

↓

↓

↓

↓

↓

↑

Foot type
(Cavus/Planus) R

C

P

P

P

P

P

P

C

P

P

P

C

C

Foot type
(Cavus/Planus) L

C

P

P

P

P

P

P

C

P

P

P

C

C

Forward bend test R

-

-

-

-

-

-

-

-

-

-

-

-

-

Forward bend test L
Backward bend test
R
Backward bend test L

-

-

+

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

March test R

+

+

-

-

-

-

-

-

+

-

-

-

-

March test L

-

-

+

-

-

-

-

+

-

+

-

+

-

Forward head

N

N

N

N

N

N

N

N

N

N

N

N

N

Forward shoulder

N

N

N

N

N

N

N

N

N

N

N

N

Y Flat

N

N

N

N

N

N

N
Y
Sway

Y

N

N

N
Y
Sway

Genu recurvatum R

<15

<15

<15

<15

<15

<15

<15

<15

<15

<15

<15

<15

<15

Genu recurvatum L

<15

Flat back/Sway back

<15

<15

<15

<15

<15

<15

<15

<15

<15

<15

<15

<15

Dome foot R

Y

N

N

N

Y

N

N

Y

N

N

N

Y

Y

Dome foot L

N

N

N

N

Y

Y

Y

Y

N

Y

N

Y

N

Loose

Tight

Loose

Loose

Tight

Loose

Loose

Tight

Loose

Tight

Loose

Tight

Tight

Tight

Loose

Loose

Loose

Tight

Tight

Tight

Tight

Tight

Tight

Loose

Tight

Tight

Loose

Loose

Loose

Loose

Tight

Loose

Loose

Loose

Loose

Tight

Loose

Tight

Loose

Thumb to thumb
Lotus
Toe Touch
HAD Straddle

>90

>90

>90

>90

>90

>90

>90

>90

>90

>90

>90

>90

>90

Psoas R

Loose

Loose

Loose

Loose

TIght

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Tight

Psoas L

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Rectus R

Loose

Loose

Loose

Loose

Tight

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Rectus L

Loose

Loose

Loose

Loose

Tight

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Loose

ITB R

Tight

Loose

Tight

Loose

Loose

Loose

Loose

Tight

Tight

TIght

Tight

Tight

Loose

ITB L

Tight

Loose

Tight

Loose

Tight

TIght

Tight

Tight

Tight

Tight

Tight

Tight

Loose

83
Sartorius R

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Tight

Loose

Loose

Loose

Loose

Loose

Sartorius L

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Loose

Tight

Tight

Tight

Loose

Hamstring R

<120

<120

>120

>120

<120

<120

>120

<120

<120

<120

>120

<120

>120

Hamstring L

<120

<120

<120

<120

<120

<120

>120

<120

>120

<120

>120

<120

>120

A dorsiflexion R

>5

<5

>5

>5

>5

<5

<5

<5

>5

<5

>5

>5

<5

A dorsiflexion L

>5

>5

>5

>5

>5

<5

<5

<5

>5

<5

>5

>5

<5

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

P subtalar joint
eversion R

>5

>5

>5

>5

>5

>5

>5

>5

<5

>5

>5

>5

<5

P subtalar joint
eversion L

>5

<5

>5

<5

<5

>5

>5

>5

>5

>5

>5

>5

>5

<90

<90

>90

>90

<90

>90

>90

<90

>90

<90

>90

<90

<90

<90

<90

>90

>90

<90

>90

>90

>90

>90

<90

>90

<90

<90

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

N

Y

Y

A plantar flexion Sym

P great toe
dorsiflexion R
P great toe
dorsiflexion L
Thomasson sign
(tight) R
Thomasson sign
(tight) L

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

N

Y

Y

HER R

<45

<45

>45

<45

<45

>45

<45

<45

<45

<45

<45

<45

<45

HER L

<45

>45

>45

<45

<45

<45

<45

<45

<45

<45

<45

<45

<45

HIR R

>45

>45

<45

>45

<45

<45

>45

<45

>45

<45

>45

<45

<45

HIR L

>45

<45

<45

>45

<45

>45

<45

>45

>45

<45

>45

<45

<45

Hamstring Avg R

24.3

9.2

13.3

15.8

13.8

10.7

11.9

14.0

9.8

9.1

15.3

11.7

11.6

Hamstring Avg L

11.2

10.7

26.4

18.6

13.3

10.5

12.7

12.9

9.2

8.9

14.9

15.0

11.0

Hamstring strength %

46%

86%

50%

85%

96%

98%

93%

92%

94%

98%

97%

78%

94%

Hip ABD Avg R

10.5

10.4

10.0

14.2

12.4

10.3

12.0

10.4

9.2

8.6

10.8

9.8

9.8

Hip ABD Avg L

11.5

10.5

9.7

15.4

10.3

9.1

12.7

10.1

8.7

9.0

12.3

10.5

8.2

Hip ABD strength % B

93%

84%

91%

99%

97%

92%

83%

88%

94%

97%

95%

96%

88%

Hip ADD Avg R

9.7

10.5

10.2

13.7

14.9

11.0

10.6

7.0

7.8

9.3

9.9

9.4

8.2

Hip ADD Avg L

11.4

11.5

8.4

13.1

11.0

8.9

9.4

9.0

7.1

9.5

9.2

10.8

8.0

Hip ADD strength % B

85%

91%

82%

96%

94%

81%

89%

77%

91%

98%

93%

87%

98%

Hip Flexion Avg R

15.9

13.4

14.7

1.7

15.8

13.3

11.6

9.6

9.1

13.3

14.5

12.8

12.3

Hip Flexion Avg L
Hip Flexion
strength%
Shoulder ABD Avg R

15.3

12.5

15.2

16.8

14.1

13.4

15.8

9.8

9.6

13.2

12.6

13.7

12.8

96%

93%

97%

99%

89%

99%

73%

98%

95%

99%

87%

93%

96%

7.7

7.1

6.3

8.2

6.0

5.0

4.7

6.4

5.2

5.9

6.7

7.2

6.3

Shoulder ABD Avg L

7.8

5.8

7.2

9.0

5.2

6.0

4.5

5.3

4.7

6.0

6.3

6.9

5.8

99%

82%

88%

91%

87%

83%

95%

83%

90%

98%

94%

96%

92%

Shoulder Abd
strength %
Kendall

P

P

P

P

P

P

P

P

P

P

P

P

P

Standing turnout°

106

110

94

85

96

118

104

104

78

91

101

90

110

disc turnout°

112

132

112

110

102

114

114

116

105

104

112

99

125

6

22

18

25

6

4

10

12

27

13

11

9

15

force differential°

84
First position relevé R

Nor

Med

Nor

Med

Nor

Med

Med

Med

Med

Nor

Nor

Nor

Nor

First position relevé L

Lat

Nor

Med

Med

Med

Med

Nor

Med

Med

Nor

Nor

Nor

Nor

calcaneal height
symmetry

N

Y

N

Y

Y

Y

Y

Y

N

N

Y

Y

N

first position parallel
plié

P

P

P

P

P

P

P

P

P

P

P

P

P

second position R

Mod

Mod

Mod

Max

Max

Max

Max

Max

Max

Max

Max

Max

Min

second position L

Mod

Mod

Mod

Max

Max

Max

Mod

Max

Mod

Max

Max

Mod

Mod

rhomberg R

P

P

P

P

P

P

P

P

P

P

P

P

P

rhomberg L

P

P

P

P

P

P

P

P

P

P

P

P

P

single leg strategy R

A/H

A/H

A/H

A

A

A

A/H

A

A

A/H

A/H

A/H

A

single leg strategy L

A

A

A

A

A

A

A/H

A

A

A/H

A

A/H

A/H

heel raises R

P

P

P

P

P

P

P

P

P

P

P

P

P

heel raises L

P

P

P

P

P

F

P

P

P

P

P

P

P

step down EO R

P

P

P

P

P

F

P

P

F

F

P

P

P

step down EO L

P

P

P

P

P

F

P

P

P

F

F

P

p

step down EC R

P

F

P

P

P

F

F

F

F

F

F

F

P

step down EC L

F

F

P

F

F

F

P

F

F

F

P

P

F

Airplane R

P

P

P

F

P

P

F

F

P

P

F

P

F

Airplane L

P

P

P

F

F

P

P

P

F

F

P

P

F

5 Pushups
plank --> side plank R
plank --> side plank L
single leg sauté ΔR/L

P
F
F

F
F
F

P
F
F

P
F
F

F
F
F

F
F
F

P
F
F

P
F
F

P
F
F

F
F
F

F
F
F

P
F
F

F
F
F

1

1

1

1

1

1

2

2

2

1

1

1

1

single leg jeté ΔR/L

1

3

4

1

1

4

2

2

4

1

1

2

0

Harvard bench step

P

P

P

P

P

P

P

P

P

P

P

P

P

85

APPENDIX C7
Corrective Exercise Pictures

86
Corrective Exercise Pictures

1)

3)

5)

2)

4)

6)

1)Plank 2)Plank with leg Abduction 3)Swiss Ball Crunch
4)Hamstring PNF/ External rotators PNF 5)Single Leg Balance
Progressions 6)Single Leg Balance Progressions

87
Corrective Exercise Pictures

7)

8)

8)
7)Self-myofascial release ITB 8)Single Leg Balance Reach
Progressions 9)Single leg hop progressions
Clark MA, Lucett SC. NASM Essentials of sports performance
training. Baltimore, MD. Lippincott Williams & Wilkins.
2010: Pictures 1-9.

88
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92

ABSTRACT
TITLE:

Preventative Functional Screening In
University Dancers: Considerations For an
Evidence-Based Training Program

RESEARCHER:

Jena A. Hansen-Honeycutt

ADVISOR:

Dr. Rebecca Hess

DATE:

May 2013

PURPOSE:

The purpose of this research was to use a
functional screen to create a profile of a
Division II university dancer.

METHODS:

This study used a qualitative research
design in which an evidence-based training
program was developed. Data was collected on
university dancers by using a functional
screen. Results of the dance screen were
organized into an Excel spreadsheet and used
to systemically identify errors to create a
profile.

FINDINGS:

The functional screen did provide
information to develop a profile of
strengths and limitations of a Division II
dancer. The profile allowed the researcher
to identify global errors that should be
addressed with a corrective exercise
program. The functional screen also assisted
in identifying underlying dysfunctions that
need to be addressed prior to starting a
corrective training program.

CONCLUSIONS:

The functional screen was an effective tool
in creating a profile of a Division II
dancer. By using the profile, the researcher
was able to identify global errors where
dancers could use corrective training to
decrease risk of injury and improve
functional movement patterns.