Elsevier

Physical Therapy in Sport

Volume 32, July 2018, Pages 15-21
Physical Therapy in Sport

Original Research
The prevalence of generalized and syndromic hypermobility in elite Australian dancers

https://doi.org/10.1016/j.ptsp.2018.02.001Get rights and content

Highlights

  • Dancers have a high prevalence of generalized joint hypermobility (GJH).

  • Professional dancers demonstrated greater hypermobility on their right leg.

  • The LLAS is superior to the Beighton score in assessing GJH in dancers.

  • A ≥6/9 cut-point for GJH is recommended if using the Beighton score in dancers.

  • Brighton and Villefranche criteria overestimate syndromic hypermobility prevalence.

Abstract

Objectives

To determine the prevalence of Generalized Joint Hypermobility (GJH) and Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome–Hypermobility Type (JHS/EDS-HT) among dancers using established validated measures.

Design

Observational Cohort Study.

Setting

Laboratory.

Participants

85 dancers from two dance institutions.

Main Outcome Measures

GJH was determined using the Beighton score (cut-point ≥5/9) and the Lower Limb Assessment Scale (LLAS) (cut-point ≥7/12). Presence of JHS/EDS-HT was assessed using the Brighton and Villefranche criteria. Paired sample t-test was performed to compare LLAS side-to-side scores, and percentage disagreements calculated to determine differences between the two GJH and the two JHS/EDS-HT measures.

Results

72% of dancers met the Beighton cut-point for GJH, while 38% and 42% met the LLAS cut-point on the left and right respectively. The proportion of dancers identified with GJH was different when assessed using the Beighton compared to the left and right LLAS (both p < 0.001), a disagreement of 48% and 46% respectively, with Beighton classifying more participants as having GJH. The Villefranche identified more dancers with JHS/EDS-HT than the Brighton (84% vs 31%, p < 0.001), with 54% disagreement.

Conclusions

High prevalence of generalized and syndromic hypermobility was found regardless of the criteria used. A higher Beighton cut-point, e.g. ≥6/9, to identify true GJH amongst dancers maybe warranted.

Section snippets

Background

Many dancers desire increased mobility in select joints to allow for aesthetically appealing ranges of movement. For some, this mobility is acquired through many years of specific training, for some through traumatic or repetitive injuries, while for others hypermobility is genetically inherited (Castori et al., 2017; Klemp & Learmonth, 1984). Regardless of the aetiology, the term Generalized Joint Hypermobility (GJH) is used to indicate individuals whose joints can actively or passively move

Methods

This cross-sectional cohort study was undertaken between June 2015 and February 2016 at two dance institutions: the West Australian Ballet and the Western Australian Academy of Performing Arts (Edith Cowan University), Western Australia. Ethical approval was obtained from two Human Research Ethics Committees: The University of Sydney (Protocol No.2015/465) and the Edith Cowan University (Project No.13174). All participants provided written-informed consent before commencement of data collection.

Results

Eighty-five dancers participated in the study representing 63% of the total invited sample. They comprised 57 pre-professional mixed genre dancers with at least 2 years full-time tertiary level ballet training (57% participation), and 28 professional ballet dancers (80% participation). No dancers were excluded based on eligibility. Demographic characteristics of gender, age, years of dancing and ethnicity are presented in Table 2. Using chi-square analysis, no difference was found between the

Discussion

High prevalence of both GJH and syndromic hypermobility was found, across all assessment tools, in our elite dancers. The 81% of pre-professional dancers with GJH, using the traditional Beighton cut-point of 4 or more, is higher than most previous reports of hypermobility among pre-professional dancers using the same cut-point, which ranged from 44% to 69% (Roussel et al., 2009; Ruemper & Watkins, 2012; Scheper et al., 2013). Interestingly, our finding of 89% GJH prevalence in the professional

Conclusions

There was a high prevalence of both GJH and JHS/EDS-HT among our cohort of elite dancers. The prevalence of GJH and JHS/EDS-HT heavily depended on the outcome measure used. The Beighton score was likely to over-estimate GJH prevalence with the commonly used cut-point of ≥4, when compared to the LLAS, which is superior for assessing lower limb hypermobility and discriminating side-to-side differences between legs. In addition, this cut-point does not account for the redundant criterion of

Conflicts of interest

None declared.

Ethical approval

Ethical approval was obtained from two Human Research Ethics Committees: The University of Sydney (Protocol No.2015/465) and the Edith Cowan University (Project No. 13174). All participants provided written-informed consent before commencement of data collection.

Funding

This work was supported by the BRIG grant from the Discipline of Biomedical Science, Sydney Medical School, The University of Sydney (grant number 2015/001).

Acknowledgements

The authors would like to thank all the dancers from the Western Australia Academy of Performing Arts and the West Australia Ballet for their participation and assistance during this study. Special thanks to Ms Jenny Woods, Physiotherapist for the West Australian Ballet, for her assistance in recruitment and support. Importantly.

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