Dancing requires a unique blend of artistry and athleticism. It is studied by individuals of all ages and comes in many forms. Given the variability of its participants and its demands, it can be associated with a broad profile of injuries. For young dancers, while some enjoy it as a form of recreation, others undergo intense and prolonged training starting at an early age with the hope of embarking on a professional career. Some researchers consider the intensity of dance second only to football [1]. Because of its high physical demand, the risk of injury can be significant. Furthermore, young dancers may be more vulnerable to such injuries due to the physiological growth process [1, 2]. Here, we highlight some important factors to be considered in assessing and managing injuries in this special population.

Risk factors for dance injury are commonly classified as intrinsic or extrinsic. Intrinsic factors are characteristics of the individual, while extrinsic factors are related to the environment or training.

Among the intrinsic risk factors, age is of particular interest, as the prevalence and type of injuries reported have been shown to vary by age [17]. Dance involves repetitive movements in non-physiologic positions and requires significant neuromuscular control and balance, which places heavy loads on the joints and their supporting structures [9, 14]. It has been theorized that pediatric dancers are vulnerable to such stressors due to maturing growth plates and the growth process itself [1, 2, 18]. There is evidence to suggest that young dancers may be at particular risk of injury during the peri-pubertal period and its associated growth spurt. While determination of pubertal onset for males can be difficult as there is no one defining characteristic, puberty typically occurs around age 12 in females, usually marked by the onset of menarche [19]. Recent research has shown that cartilage active throughout the pubertal growth spurt may be more susceptible to injury than immature or mature bone [1]. The loss of flexibility that occurs during this time period, as bones grow faster than ligaments and tendons, has also been theorized to increase injury risk [20, 21]. Overall, the intensive and specialized training required of dancers may create conditions that cause the growth process to predispose the adolescent dancer to injury. However, there is no clear consensus based on the current literature confirming the relationship between age, growth, and injury.

While other intrinsic risk factors have been studied extensively, few high-quality studies have emerged. A recent systematic review evaluated the current evidence regarding risk factors for musculoskeletal injury in pre-professional ballet and modern dancers, aged 18 years or younger, but, due to the lack of studies worthy of full consideration in the review, no definitive conclusions could be reached [22]. There was low-level evidence suggesting that previous injury, insufficient psychological coping skills, low body mass index, poor aerobic capacity, abnormal lower extremity alignment in turnout, and perfectionism may be associated with increased risk of injury in pre-professional young dancers [22]. Studies on additional intrinsic risk factors in young dancers have shown inconsistent results.

Extrinsic risk factors hypothesized as contributors to dance injury include poor technique, improper training, inappropriate scheduling to prevent fatigue, lack of strengthening to prevent muscular imbalances, and suboptimal equipment, including footwear and floor type [23]. These are areas of particular interest, as they are modifiable aspects of training. In the aforementioned systematic review, only jump landing technique and fatigue had low-level evidence to suggest an association with injuries in young dancers [22]. In a study by Liederbach et al., adult professional dancers were shown to have different landing kinetics/kinematics and increased resistance to fatigue-induced changes compared to other female athletes, who incur higher rates of ACL injuries. Prevention of fatigue and proper jump technique were therefore proposed as protective mechanisms against specific injuries, including ACL injuries [24, 25]. These results have been echoed in studies that have linked training intensity with increased injury incidence among adolescent dancers [21]. However, despite the vast quantity of studies examining extrinsic risk factors, insufficient high-quality data exist to make definitive conclusions regarding extrinsic risk factors for musculoskeletal injury in young dancers.