In “past, present, future”, we ask clinical or academic experts to reflect on selected Sports & Exercise Medicine topics. Today Nico Kolokythas on Injury Prevention in Dance.




Tell us more about yourself.

I am a strength and conditioning coach with 20-year experience in the athletic development of adolescents in elite performance in a variety of sports (Judo, Netball, Basketball, Football, Taekwondo, Tennis). Based at Elmhurst Ballet School, U.K. I completed a PhD in injuries and the adolescent ballet dancer, and I also work as a consultant for Birmingham Royal Ballet. As part of my studies, I led randomised controlled trials in injury prevention in dance, and I have now developed an injury prevention intervention called “11+Dance”. I am a regular presenter at the International Association of Dance Medicine and Science conferences and a regular writer/contributor for One Dance UK’s magazine. Since 2014, I have been a visiting lecturer at the University of Wolverhampton and recently became a visiting lecturer at Bern University. My focus in teaching is on coaching and training methods as well as motor learning & control.


What was hip and happening 10 years ago?

Ten years ago, injury prevention research in dance was at an infancy stage. That’s not to say that practitioners were not actively trying to understand and positively affect the injury incidence in the sector. Injury prevention as a concept was an attempt to predict the factor(s) that may cause injuries. Low-intensity exercise was mainly supplementary exercise, and there were assumptions that this training method was beneficial against injuries.  Peer-reviewed publications were reporting high injury rates, mainly in the lower limb and of overuse onset. The studies were either cross-sectional or longitudinal observations in organisations that had established a dance medicine department. The main outcome was that proactive exercise prescription was an effective way of reducing injury incidence in professional dancers. There was no clear reporting on the intervention that was utilised, therefore, numerous confounding factors made the replication of those studies impossible. It is important to keep in mind that the information we have cannot be generalised as they do not include data from all possible countries (e.g., Russia, China, Japan).


What are we doing now?

The establishment of multidisciplinary health care teams in more vocational dance schools and professional dance companies around the globe is one of the fundamental differences now. As it was the case in professional sport, this started in large professional dance companies and then trickled down to the education sector. This is allowing for more longitudinal studies to come to surface. Injury data is prospectively collected, and injury reporting is more consistent, therefore, data will be more informative when meta-analysed. Injury prevention intervention research is still scarce in dance. The sector, apart from a handful of organisations, is still reactive to the burden of injuries and dance practice is still led by experience and tradition. In the words of the great physiologist Craig Sharp “proximity is the key to success”, active researchers are now employed within the health care team. This makes science part of the organisation culture and therefore, research becomes more organic.


Where do you think we will 10 years from now?

We need to make sure there is clarity and transparency with the terminology and the methodology we utilise. There is some noise around the word prevention and how we cannot prevent injuries, especially since their incidence is multifactorial. This is true when we are talking about one dancer, we cannot guarantee or predict that the implementation of an intervention will prevent one dancer from getting injured. Implementing an injury prevention intervention in an organisation (e.g., a school), however, can potentially reduce the injury incidence for the selected cohort/organisation by reducing the associated risk factors. The observed reduction would mean that some injuries would be prevented from happening. So, whilst we cannot predict, we can prevent!

Moreover, research must become more connected and integrated with practice. Researchers need to be more informed about the process of evidence-based practice following paradigms from clinical practice, where outcomes are guided by the end-user. The dance sector needs to utilise implementation strategies that are already tried and tested in the exercise and health sector. Implementation strategies will improve the communication of the scientists, the dance practitioners, the dancers, and the CEOs of the organisations. The existing successful examples of good practice are an asset to the sector and need to be utilised further. Researchers need to produce more evidence on injury prevention through transparent good quality research and thus, replicable research protocols. There needs to be a bottom-top and not simply a top-down approach, in order to achieve this change. Bottom-up can be initiated through education of the youth (grassroots) as part of a holistic long term dancer development plan. We, the science community, have an obligation to disseminate accurate information at an early stage of the dancer’s development. Top-down would mean getting key stakeholders onboard as part of an effort to improve the longevity of the dancer and understand the financial benefits of proactive actions against injuries. In addition, implementation strategies should be focusing on disseminating existing evidence to organisations that are currently with no structured dance medicine and science support. The health of the dancers who are working in these organisations is at higher risk. And of course, we cannot forget the freelance dancers, as they are hard to reach but in need of support too.


Would you like to learn more on this topic? Here is a selection of studies on ‘Dance Medicine’ published in our journal.
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