PURPOSE: Bone stress injuries (BSI) result in substantial time-loss in classical ballet dancers. In 2022, 87% of recreational dancers in Australia were female. Injury prevention strategies promoted by elite dancers may be widely adapted in the community. The purpose of this research was to engage stakeholders in an elite classical ballet company to contribute to the co-creation of BSI prevention strategies, with the aim of increasing the likelihood of implementation. 

 

METHODS: Participatory action research (PAR) is a qualitative methodology. Stakeholders (n=17) from diverse backgrounds within an elite ballet company volunteered to participate. Their roles included: Coaching (artistic) staff, current/former dancers, performance health providers, engagement officers, events, marketing, facilities management, and philanthropy. Four sequential meetings occurred between March-June 2023 which were recorded, transcribed and coded thematically using ATLAS.ti (ATLAS.ti Scientific Software Devel. GmbH). Guide questions and prior meeting analyses were presented to the group to develop discussion. In the final meeting, the group drafted a BSI prevention proposal for the organisation.  

 

RESULTS: Cultural barriers to BSI prevention were recognised. Dancers may not identify as athletes, preventing them from accessing health information and care appropriate for high performing individuals. The group discussed professional dancers as health role models for community dancers, as well as the onflow of poor grassroots health behaviours to an elite setting. Contributors to BSI discussed were poor health literacy, early specialisation, and unstructured cross-training in the community. The artistic process, poor nutrition, lack of load monitoring strategies, and glorification of dancing through injury/pushing through pain were identified as barriers in both elite and community settings. Systemic barriers such as funding, and community access to dance-informed health practitioners were identified. 

 

Priorities for prevention in the elite setting were improving access to onsite health services, annual health evaluations, refining safeguarding policies in the studio, and investigating wearable technology options for load monitoring. Priorities for prevention in the community included education and outreach programs for dancers, teachers and parents. Health literacy surveys and ongoing epidemiology surveillance were recommended to measure effectiveness of implemented interventions. 

 

CONCLUSION: PAR was a successful method to develop actionable strategies for BSI prevention in a classical ballet company. Interdisciplinary collaboration allowed for a proposal to be developed for delivery to the senior leadership and governing board of the organisation. Future research is required to implement and determine the effectiveness of proposed BSI prevention strategies.