Dance Exposure, Individual Characteristics, and Injury Risk over Five Seasons in a Professional Ballet Company

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PURPOSE: This study aimed to describe the relationships between dance exposure, dancer characteristics, and injury risk across five seasons in a professional ballet company. METHODS: Dance exposure time and clinician-reported time-loss and medical attention injury data were prospectively collected from 118 professional dancers of The Royal Ballet between 2015/2016 and 2019/2020. Cox proportional hazards and shared frailty models were fitted to overuse and traumatic injuries; individualized robust Z-scores for 7- and 28-d accumulated exposure, and week-to-week change in exposure, age, sex, company rank, and injury history were included as time-varying covariates. RESULTS: Across 381,710 h of exposure, 1332 medical attention and 427 time-loss injuries were observed. Positive relationships were observed between week-to-week change in exposure and overuse time-loss (+1 Z-score hazard ratio (HR), 1.27; 95% confidence interval (CI), 1.06-1.53) and medical attention injury risk (+1 Z-score HR, 1.17; 95% CI, 1.06-1.28). A negative relationship was observed between 7-d accumulated exposure and overuse medical attention injury risk (+1 Z-score HR, 0.74; 95% CI, 0.66-0.84). Overuse time-loss injury risk was greater in soloists compared with the corps de ballet (HR, 1.47; 95% CI, 1.01-2.15) and in dancers with a higher previous injury rate (+1 injury per 1000 h HR, 1.06; 95% CI, 1.02-1.10). Only age was associated with traumatic time-loss (+1-yr HR, 1.05; 95% CI, 1.01-1.09) or medical attention injury risk (+1-yr HR, 1.04; 95% CI, 1.01-1.07). CONCLUSIONS: Professional ballet companies should implement training principles such as periodization and progression, particularly in the case of senior-ranking dancers, older dancers, and dancers with high rates of previous injury. These findings provide a basis for future prospective investigations into specific causal injury pathways.