Injury Occurrence in Modern and Hip-Hop Dancers: A Systematic Literature Review

While they are primarily performing artists, dancers are often also regarded as athletes. Performing dance at a high level requires sophisticated physical capacities (aerobic and anaerobic energy utilisation, muscular strength and endurance, speed, balance, coordination, agility, flexibility and motor control) allied to aesthetics (1). Professional and non-professional dancers alike are an embodiment of the achievements that can result from rigorous training and mastery of technique. As dance involves a high number of repetitions, dancers risk injury by exceeding the limits of their anatomical and physiological capabilities (2). Most dancers begin training at a young age, so there is the potential for injuries to have a significant impact on their future health (3). Injuries and health problems have result in financial outlays for individuals, dance companies and the health system (4). However, as an occupational group, modern and hip-hop dancers have received little attention in the health literature to date (5).

Interest in dance-related injuries has widened in recent years, with several new reviews published (3, 5, 6, 7). However, most of these reviews are of research papers that investigate ballet injuries―indeed, this dance discipline is by far the most common point of interest for researchers (8). Although similarities between different dance styles exist, there are also differences in technique and in the movements dancers incorporate into their repertoire. Since its origins in the early part of the 20th century, modern dance has seen advances in technique brought about by choreographers and dancers such as Graham, Limon, Horton, Cunningham, Nikolais/Luis and Hawkins (9). Hip-hop dance, on the other hand, is a type of freestyle dance with a shorter history than that of modern dance. It was initially performed to hip-hop music by young people in the streets (10) and has several styles, divided into Old School (e.g. breaking, popping, locking) and New School (e.g. house, krumping, street jazz) (11). Street dance styles and modern dance have increased in popularity in recent years and are becoming part of many young people’s lifestyle (12). Moreover, dance schools are being set up in large numbers and are competing at national and international championships, and performing in theatres and at shows and concerts. All this requires class- and rehearsal-based training. Slovenia has approximately 2,500 registered dancers, half of them in hip-hop. Around 25% of all registered dancers compete in hip-hop and are under 15 years of age. Studies have shown that the most common modifiable risk factors for dance injuries are anthropometrics, joint range of motion, age and dance exposure (7).

Because injury occurrence in modern and hip-hop dance is not yet well-documented (but seems to play a significant role in the health status of young dancers), the aim of this literature review was threefold:

to investigate the epidemiology of injuries in modern and hip-hop dance in order to highlight the magnitude of the problem;

A systematic literature review of the MEDLINE (PubMed) research database was conducted in June 2019 in line with the recommendations of the Preferred Reporting Intensity for Systematic Reviews and Meta-Analyses (PRISMA) (13). The search for relevant articles was performed using MeSH Terms, as follows: (“wounds and injuries” [MeSH Terms] OR (“wounds” AND “injuries”) OR (“wounds and injuries” OR “injury”) AND “modern” AND “hip-hop” AND “break” AND (“dancing” [MeSH Terms] OR “dancing” OR “dance”).

A literature review search revealed 74 studies. They were evaluated in accordance with the revised title and abstracts. Thirteen studies were then taken for further review. Only nine research papers met the inclusion criteria for the systematic literature review (Figure 1).

Figure 1

All studies included in this literature review investigated injury occurrence among modern, hip-hop or break dancers. Six of them looked at modern dancers (14, 15, 16, 17, 18 , 19), two investigated injuries in break dance (20, 21) and only one paper addressed hip-hop dance (22). The research design, number of participants, main outcome measures and conclusions of all nine studies are summarised in Table 1 (prospective studies) and Table 2 (retrospective studies).

In four studies, the authors retrospectively examined injury occurrence, and their location, severity and correlation with demographic and dance characteristics (18, 20, 21, 22); Jacobs et al. (16) compared injuries in modern dance and ballet in a cross-sectional study; three studies were prospective cohort studies (14, 15, 17); and one study retrospectively reported injuries and then prospectively investigated the effect of comprehensive management intervention on injury incidence and cost (19).

The authors of five of the studies reported numbers of acute and traumatic injuries (14, 15, 17, 19, 20 ), while five studies presented injuries per 1,000-hours of dance exposure (14, 15, 17, 18, 19). Jacobs et al. (16) stated injury prevalence only (Table 3).

The purpose of this systematic literature review was to search for studies that investigated injuries in modern and hip-hop dance. As Russell (1) points out, studies have mostly investigated injuries in ballet. It is therefore not surprising to find that only 74 records were identified when searching only for injuries in modern, hip-hop and break dance. Furthermore, after eliminating review articles, pilot studies and case reports, and excluding inappropriate full texts, only nine studies were included in our literature review.

This systematic literature review identified differences in injury incidence rates between modern and hip-hop dance (break dance in particular). As dance-related injuries seem to be of major concern, researchers may consider conducting further investigation into dance styles such as hip-hop, not only through self-report questionnaires but also by carrying out screening tests (23) and preventive programmes (which showed a reduction in dance-related injuries (24)), and by involving other healthcare workers.