Dance screen programs and development of dance clinics.

Dance is an art form that combines technical skill, muscular strength, muscular endurance, cardiovascular fitness, and aesthetics. The purpose of the dance movement is to stimulate the observer's senses and evoke emotions or thoughts. In contrast, the purpose of movement in many athletic activities is the achievement of a specific goal, such as hitting a target, completing a pass, running the fastest, jumping the highest, out-maneuvering an opponent, or scoring a goal. As such, the movement in these sports is not as critical as the end result of the movement. Certainly there are athletes whose graceful and fluid movements are visually pleasing as well as technically efficient. This is one reason for spectator appreciation, but it usually is less important than scoring or winning. On the other hand, in sports such as diving, skating, synchronized swimming, freestyle skiing, rhythmic gymnastics, and classic gymnastics, artistic impression or gracefulness is critical to athletic success. In dance, the importance of the movement itself is taken one step further. For the most part, there are no scores, no records to set, and no opponents to defeat ; success is determined by audience gratification based on visual, emotional, spiritual, or intellectual impact. The final position or the goal achieved by performing a movement is not nearly as important as the totality of the movement. In dance, the movement is the substance of the activity. The movement in dance can be stressful to the body. It is often performed at the extremes of range of motion, where muscles are shortened or stretched to lengths that provide for suboptimal contraction and power. At or near these endpoints of joint mobility, ligaments are taut, undergoing strain that can lead to injury. In these positions, extra-articular portions of bones, such as the tibia and calcaneus, which normally would not contact one another, may impinge, obstructing movement and irritating intervening or surrounding tissues. Tendons fully tensioned and subjected to the eccentric contractions of the muscles are pulled sharply around jutting bony prominences and through restrictive fibrous pulleys. Nerves, too, are stretched under edges of ligaments, retinaculum, and fascia or compressed between adjacent anatomic structures or against external structures, such as shoes, ribbons, or the floor. Thus, at the extremes of the dancer's mobility, the movements, so striking or beautiful to the audience, are stressful to the dancers and may place many physiologic structures at risk for acute, subacute, or chronic injury. 1,3,5,6,10,11 Injury, especially chronic injury, may also develop from inefficient patterns of movement developed during the early stages of training. As the dancer struggles to execute new dance movements, muscles may be used inappropriately ; such habitual misuse can cause an overdevelopment of some muscles and leave other muscles weak or overstretched. Because dance is repetitious, these acquired imbalances may ultimately cause injury. Unlike the athlete who has benefit of an athletic trainer, coach, team doctor, and frequently a dedicated physical therapist, a dancer is often isolated from health care providers. Dancers seeking medical advice will often consult and receive information from instructors, dance colleagues, and, at times, a therapist or medical practitioner who may or may not have adequate knowledge of either the specifics of dance or of dance injury. 1 Currently, many major dance companies have a dedicated orthopedist and physiatrist available for consultation. Unfortunately, the accessibility to appropriate medical advice for participants in smaller companies and many college and high school level dance schools is still limited. These issues indicate that a preseason or yearly screening of dancers would be beneficial, as it is with preseason screening for other sports participants 3,8 Therefore, we have established a dance screening protocol at The Un