{"id":6314,"date":"2019-02-14T06:30:39","date_gmt":"2019-02-14T12:30:39","guid":{"rendered":"http:\/\/thesportjournal.org\/?p=6314"},"modified":"2019-02-13T08:47:53","modified_gmt":"2019-02-13T14:47:53","slug":"biomechanical-comparison-of-dead-and-new-pointe-shoes-in-female-professional-ballet-dancers","status":"publish","type":"post","link":"https:\/\/thesportjournal.org\/article\/biomechanical-comparison-of-dead-and-new-pointe-shoes-in-female-professional-ballet-dancers\/","title":{"rendered":"Biomechanical Comparison of \u201cDead\u201d and \u201cNew\u201d Pointe Shoes in Female Professional Ballet Dancers"},"content":{"rendered":"\n

A<\/strong><\/em>uthors: <\/strong>Jessica Aquino, MS and Tal Amasay, PhD <\/p>\n\n\n\n

Corresponding Author: <\/strong>
Tal Amasay, PhD, CSCS, EPC
11300 NE 2nd<\/sup> Ave
Miami Shores, FL 33161
tamasay@barry.edu<\/a>
305-899-4893<\/p>\n\n\n\n

Jessica\nAquino has a master degree in movement sciences, is a certified athletic\ntrainer, and work with professional Ballet dancers. Tal Amasay is associate\nprofessor at Barry University and the head of the Motion Analysis Center. He is\na certified exercise physiologist and certified strength and conditioning\ncoach  <\/p>\n\n\n\n

Biomechanical\nComparison of \u201cDead\u201d and \u201cNew\u201d Pointe Shoe in Female Professional Ballet\nDancers<\/strong><\/h3>\n\n\n\n

ABSTRACT<\/strong><\/p>\n\n\n\n

Purpose:\nAvailable research on pointe shoes often compare pointe shoes to other dance\nfootwear, however there is a lack of studies comparing dancers\u2019 biomechanics\nwhen using \u201cnew\u201d pointe shoes and pointe shoes that have worn down, \u201cdead\u201d. The\naim of this study was to examine the biomechanical differences exhibited by\nprofessional ballet dancers while performing relev\u00e9, sous-sus, and pirouette in\n\u201cdead\u201d and \u201cnew\u201d pointe shoes. Methods:\nThirteen female (20.9 \u00b1 1.9 years old) professional ballet dancers were asked\nto perform three trials of relev\u00e9, sous-sus, and pirouette in \u201cnew\u201d pointe\nshoes and \u201cdead\u201d pointe shoes. Center of pressure sway area and ground reaction\nforces in the anterior-posterior, medial-lateral, and vertical directions were\nrecorded using one AMTI force plate. Results:\nThe \u201cdead\u201d pointe shoe condition had significantly higher sway area during\nrelev\u00e9, sous-sus, and single pirouette (103 \u00b1 95 mm2<\/sup>; 256 \u00b1 133 mm2<\/sup>;\n178 \u00b1129 mm2<\/sup>, respectively) than the \u201cnew\u201d pointe shoe condition (50\n\u00b1 65 mm2<\/sup>; 110 \u00b1 64 mm2<\/sup>; 77 \u00b1 39 mm2<\/sup>,\nrespectively),  p-value<\/em> < 0.05. In addition, peak ground reaction force in the\nanterior-posterior direction during relev\u00e9 movement was higher in \u201cnew\u201d pointe shoes\n(35 \u00b1 6% body weight) than in \u201cdead\u201d pointe shoes (32 \u00b1 6% body weight), p-value<\/em> = 0.019<\/em>. No significant differences were observed for the other\ndependent variables. Conclusions:\nA larger sway area was observed in \u201cdead\u201d pointe shoes compared to \u201cnew\u201d pointe\nshoes, which indicates that the participant had less balance in the \u201cdead\u201d\npointe shoes than in the \u201cnew\u201d pointe shoes. The larger sway area in \u201cdead\u201d\npointe shoes may indicate that decrease in shoe integrity may contribute to\ndecrease in the support and stability of the pointe shoe while the ballet\ndancer maintains the \u2018en pointe\u2019 position. Moreover, higher forces in the\nanterior direction state that the dancers can apply more forces in the \u201cnew\u201d\npoint shoe. Application in sport: These results can educate ballet teachers and\nballet dancers about the mechanical changes in \u201cdead\u201d pointe shoes, which may\nlead to injury and reduce in performance. Furthermore, these results may lead\nto enhancements in footwear design.<\/p>\n\n\n\n\n\n\n\n

Keywords<\/strong>: Balance, Ground Reaction Forces, Ballet, Pointe Shoe <\/p>\n\n\n\n

INTRODUCTION<\/strong><\/p>\n\n\n\n

The field of sports medicine and\nperforming arts medicine continues to expand and recognize dancers as athletes\nand aesthetic performers who have their own set of difficulties and common\ninjury trends similar to other traditional sports. Ballet dancers, both male\nand female, extensively train daily throughout their careers. Professional\ndancers train and perform in excess of 60 hours a week. Pre-professional\ndancers train and perform about 30 hours a week. Dancers that are still in\nprimary or secondary dance schooling train and perform less than 30 hours a\nweek (15). The prevalence of injuries in\nyouth, amateur, and professional dancers was reported as 0.97 injuries per 1000\ndance hours for males, and 1.24 injuries per 1000 dance hours for females (14). Gamboa, Roberts, Maring, & Fergus (4), reported a five year rate of injury of 0.77\ninjuries per 1000 dance hours (4). Smith\net al. (14) and Steinberg et al. (15), identified chronic\/overuse injuries as\nthe most common injuries, where amateur ballet dancers showed a higher\nproportion of overuse injuries than professionals (14, 15). Male professional dancers showed a higher proportion of\ntraumatic injuries than overuse injuries, when compared to female professional\ndancers (4, 14). Current research in\ndance and sports medicine points to the prevalence of lower extremity injuries\nin ballet dancers; however, research lacks evidence that identifies the\npossible underlying causes of these injuries (4,\n5, 7, 13-15). It has been identified that up to 85% of dance-related\ninjuries are in the lower extremities (4, 5, 8,\n14, 15). The most common injuries in dancers include lateral ankle\nsprains, Achilles\u2019 tendinopathy, Lisfranc injuries, flexor hallicus longus\ntendinopathies, anterior cruciate ligament injuries, meniscal injuries in the\nknee, snapping hip, labral tears in the hip joint, and low back pain (4, 5, 7, 8, 13-15).<\/p>\n\n\n\n

Dancing en pointe means the ballet dancer\nis dancing on her toes. Dancing in pointe shoes creates a magical illusion of\nthe dancer floating while dancing. To meet the choreographic and aesthetic\ndemands pointe shoes were developed. As pointe shoes gain more wear and tear,\nthe normal biomechanics and ankle stability of professional ballet dancers\nperforming simple ballet combinations may be negatively affected, possibly\ncausing the ballet dancers to compensate and leading to a higher risk of acute\nand chronic lower extremity injuries, especially ankle injuries. Few studies\nexist that analyze the effects of different types of dance shoes on dancers (8, 13). Studies that focus on footwear in\ndance examine differences in types of shoes as well as differences in shapes of\nshoes (2, 16). Cox and Herzog (2) concluded that there are no significant\ndifferences in the proprioception of novice ballet dancers when balancing on\npointe shoes with different toe box shapes (2).\nWalter et al. (16) found significantly\nlarger forces on the lower extremities when landing in flat ballet technique\nshoes versus landing in pointe shoes, speculating that the increase in\nmaterials around the forefoot and toe box could account for the shock\nabsorption noted in the study (16). <\/p>\n\n\n\n

There is a lack of research which examines\nthe effects of \u201cwear and tear\u201d or loss of shoe integrity on the biomechanics of\nballet dancers. Training in \u201cdead\u201d pointe shoes (pointe shoes that are too old)\nmay be similar to a track athlete or runner who trains in old athletic footwear\nfor too long. In general, most experts will suggest to runners to change their\nrunning shoes every 300 to 400 miles (6, 10, 12).\nIt is well established in running research that when the shoe support and\ncushioning decreases, runners modify their patterns to maintain comfortable and\nconstant loading (6). The same can be\nassumed for all athletes and their specific footwear, specifically for ballet\ndancers when their pointe shoes begin to soften. Unlike running shoes, which\nprovide both shock absorption and support, ballet pointe shoes have little\nsupport or shock absorption (7, 13).\nPrimarily, they are designed to maintain the foot in the en pointe position, or\nfully plantarflexed (7, 13).<\/p>\n\n\n\n

Despite the understanding that better\ncushioned shoes may help reduce ground reaction forces when landing and provide\nshock absorption to reduce the chance of lower extremity pathology, dancers are\nunlikely to change or modify the traditional footwear. The reason is associated\nto the specific \u201cfeel\u201d of the floor by their feet which is essential to their\nsuccess in performance and dancing (13).The\nintegrity and strength of the shoe wear down with use, possibly causing the\nballerina to compensate while training or performing, similar to runners who\ncompensate due to improper footwear (10, 12).\nImproper technique has also been identified as a concern and risk for injuries\nin dancers, leading to overuse and acute injuries (7, 13). Ballet and dance are complex art forms that encompass many\ndiffering movements, techniques, levels, and genres. In this study, researchers\nexamined footwear as one of the possible causes for overuse injuries in\nprofessional female ballet dancers. The purpose of this study was to examine\nground reaction forces and center of pressure differences exhibited by female\nprofessional ballet dancers while performing sous-sus, relev\u00e9, and a single\npirouette in \u201cdead\u201d and \u201cnew\u201d pointe shoes.<\/p>\n\n\n\n

METHODS<\/strong><\/p>\n\n\n\n

Participants<\/strong><\/p>\n\n\n\n

All participants recruited for the study\nwere female, professional level ballet dancers currently hired by a\nprofessional ballet company. Thirteen professionally employed ballet dancers\nvolunteered to participate in the study (Table 1). All participants gave\ninformed consent prior to data collection and the study was approved by the\nuniversity\u2019s Institutional Review Board (IRB) committee. All ballet dancers had\nover 10 years of experience and training on pointe shoes. Inclusion criteria\nrequired participants to be injury free for at least three months prior to data\ncollection, and were presently not experiencing any limiting pain that may\nhinder their performance. Each dancer brought two sets of their own pointe\nshoes; \u201cdead\u201d and \u201cnew\u201d. Individual participants were allowed to determine which\npointe shoe pair was considered \u201cdead\u201d to ensure levels of comfort when\nparticipating in the study. The manufacturers of the pointe shoes were not\nregulated between participants. Participants used pointe shoes that have\nalready been trained in for at least 1 rehearsal or class but for no more than\n3 months of rehearsals and classes.<\/p>\n\n\n\n

\"Table<\/figure>\n\n\n\n

Procedures<\/strong><\/p>\n\n\n\n

All data were collected using an AMTI Force Plate (Watertown, MA) at a sampling rate of 960Hz. Participants were asked to arrive at the lab for a one-hour session at their assigned time. Upon arrival, participants filled out the pre-session questionnaire and signed a consent form approved by the university IRB committee. Participants were asked to wear common dance attire, which included tights that covered their toes, leotards, and a skirt, which was optional. Participants were asked to bring their own pointe shoes, a pair that is relatively \u201cnew\u201d and a pair that is relatively \u201cdead\u201d, or old. Pointe shoes were not used if they were brand-new and straight out of the box, as the dancer has not broken them in which could cause injury and alter their biomechanics. \u201cNew\u201d pointe shoes were defined in this study as the pointe shoes that the ballet dancers were currently training in. The shoes were not brand new, out of the box, unbroken in, or without having been trained in. \u201cDead\u201d pointe shoes were defined in this study as pointe shoes that have been worn for many training hours or performances which cause them to wear down, at the shank and toe box specifically. The sole and toe box were examined by the researcher to make sure that both conditions were still safe for the dancers to use for this study to avoid potential injuries. Because there is still no hard definition for a \u201cdead and \u201cnew\u201d pointe shoes the participants subjectively determined if a pointe shoe was \u201cdead\u201d\u00a0 or \u201cnew\u201d. Based on this \u201cnew\u201d pointe shoes were within the range of 5 to 50 training hours and \u201ddead\u201d pointe shoes were within the range of 51 to 400 training hours (Table 2).<\/p>\n\n\n\n

\"Table<\/figure>\n\n\n\n

Participants\u2019 anthropometrics were taken\nbefore beginning the trial sequences. Sequence of pointe shoe conditions and\nballet movement were randomized between participants. The participants were\nallowed to warm up as they would for class as well as practice before\ncollecting the trials to ensure they are comfortable with the space, equipment,\nand flooring. The participants were asked to perform at least two proper trials\nof the following ballet moves: sous-sus, relev\u00e9 in second, and a single\npirouette. Participants were allowed to rest at least 30 seconds between trials\nand movements to ensure that fatigue is not a factor. If, for any reason, the\ndancer did not complete the movement with control or fell out of the data\ncollecting volume, the participant was asked to repeat the trial.<\/p>\n\n\n\n

During the sous-sus trials, the\nparticipant was asked to begin in fifth position with her right foot in front.\nThe participant was instructed to sous-sus, in which she springs up from flat\nto en pointe in fifth position. Then the participant was instructed to maintain\nthe en pointe position for at least a second and then come down into flat fifth\nagain. During the relev\u00e9 trials, the ballerina was instructed to start in\nsecond position with the left foot on the force plate. She was instructed to\ndemi-pli\u00e9 first, to rise into relev\u00e9, maintain the en pointe position for at\nleast a second and then come down into flat second position through demi-pli\u00e9.\nDuring the single pirouette trials, the participant was asked to start in\nfourth position with her turning leg on the force plate. She was asked to\nperform a single pirouette and land back in fourth position. <\/p>\n\n\n\n

Data Analysis <\/strong><\/p>\n\n\n\n

Data collected were processed using Nexus\n2.2.3 (Vicon, Oxford, UK), and analyzed using Polygon 3.5.2 (Vicon, Oxford ,\nUK) as well as Excel 2010 (Microsoft, WA, Redmond, USA). Data were filtered\nwith a Butterworth Trajectory filter with a cutoff frequency of 20 Hz before\nthe analysis. This study was a repeated measures design. Each of the\nparticipants completed each movement in both conditions, \u201cnew\u201d pointe shoes and\n\u201cdead\u201d pointe shoes, and performed the three movements: sous-sus, relev\u00e9, and\npirouette. The dependent variables analyzed were the sway area and peak ground\nreaction forces in all directions. The quiet stance of the movements was identified\nby examining the vertical ground reaction forces during the middle one second\nof the trial. Ground reaction forces in all directions were normalized to body\nweight for each participant. Sway area was estimated by an area of an ellipse.\nTo find this, the ranges of the center of pressure (COP) in both\nanteroposterior and mediolateral directions were calculated then divided by two\nto find the radius in each direction (9).<\/p>\n\n\n\n

Results<\/strong><\/strong><\/p>\n\n\n\n

Using SPSS Statistics 19 Software (IBM,\nArmonk, NY), a two-way repeated measures MANOVA was used to statistically\nanalyze the average of two\ntrials of each movement in each shoe condition for each of the participants.\nPreliminary multivariate testing showed no significant\ninteraction between condition and movement (F(14,78) = 0.784, p > 0.05);\nhowever, there were significant main effects between shoe conditions (F(7,78) = 3.615, p = 0.02). A Bonferroni post hoc test was performed to find\nsignificant differences between movements within each dependent variable. The\nsway area of oscillation was significantly higher in the \u201cdead\u201d shoe condition\n(Fig. 1) as compared to the \u201cnew\u201d shoe condition (Fig. 2) in all three\nmovements (p < 0.05). The peak force in the anterior-posterior direction was\nsignificantly higher in the \u201cnew\u201d shoe condition as compared to the \u201cdead\u201d shoe\ncondition during Relev\u00e9 \u00e0 la seconde condition (p < 0.05) (Table 3). There\nwere no significant differences between shoe conditions for any of the other\ndependent variables (p>0.05) (Table 3).<\/p>\n\n\n\n

\"Table<\/figure>\n\n\n\n

DISCUSSION<\/strong><\/p>\n\n\n\n

Statistically significant differences during all three movements occurred between the shoe conditions, \u201cnew\u201d and \u201cdead\u201d, when measuring the sway area of oscillation during quiet stance. Higher sway areas were observed in the \u201cdead\u201d pointe shoe condition than in the \u201cnew\u201d pointe shoe condition. The mean sway area in \u201cdead\u201d pointe shoes during relev\u00e9, sous-sus, and pirouette were higher by 53 mm2<\/sup>, 146 mm2<\/sup>, and 101 mm2<\/sup>, respectively. Having a significantly larger area of sway in \u201cdead\u201d pointe shoes suggests that the \u201cdead\u201d pointe shoe condition may lack support and contribute to less stability in the foot and ankle joint for ballet dancers when up on their toes. As the muscles of the foot activate to correct balance during quiet stance (en pointe phase), a significantly smaller area generally represents greater proprioception, keeping the center of pressure under better control (2). The larger sway area in \u201cdead\u201d pointe shoes can indicate a lack of support and stability from the shoe to help the ballerina maintain her \u2018en pointe\u2019 position. <\/p>\n\n\n\n

A shift of center of pressure is an accepted, indirect\nmeasure of postural sway and also a measure of a participant\u2019s ability to\nmaintain balance during tasks (3, 9, 11).\nPrevious research has linked changes in postural sway with ankle physiology and\npossible injury risks at all lower body joints, not just the ankle (1, 3, 11). For ballet dancers, an increased\nsway area indicates a higher risk of instability and possibly a higher demand\nfor compensation techniques in order to maintain balance en pointe.\nCompensation can lead to injuries, commonly overuse, in the foot and ankle\njoints. If the stability provided by the pointe shoe begins to fail or\ndecrease, the ballerina may compensate in order to maintain the en pointe\nposition. If she cannot compensate to hold the position she may fall out of the\nposition, which may lead to a traumatic injury or the inability to complete the\ntask or movement on hand.<\/p>\n\n\n\n

Significant difference was observed in the\nanterior-posterior direction ground reaction force during relev\u00e9; \u201cnew\u201d shoes\nhad higher peak force than \u201cdead\u201d shoe. Although not statistically significant,\nthere were noticeable differences in ground reaction forces in the vertical\ndirection and shoe conditions.  The\naverage ground reaction forces were larger in the \u201cnew\u201d pointe shoe condition\nversus the \u201cdead\u201d pointe shoe condition. The averaged difference in peak ground\nreaction forces in the vertical direction during relev\u00e9, sous-sus, and\npirouette were 1% BW, 5% BW, and 9% BW, respectively. The \u201cnew\u201d condition of\nthe pointe shoe is stiffer, so the ballet dancers have the need to push harder\nto overcome the friction on the floor as well as more trust that the shoe will\nsupport them during the movements. The \u201cdead\u201d shoes may be less supportive to\nhandle quick and forceful movements during a full performance weekend, and may\ninfluence the dancer\u2019s decision making. However, the lack of knowledge about\nthe time a pointe shoe becomes \u201cdead\u201d may expose the ballerina to higher risk\nfor injury.<\/p>\n\n\n\n

The manufacturers of each pointe shoe used in this study were\nnot controlled for due to the differences in how the shoes are made, including\nthe width of the toe box and the length of the shank. The participants were\nalso the ones who determined whether the shoe was \u201cnew\u201d or \u201cdead\u201d according to\ntheir personal standards and levels of comfort. This could influence the\nresults of the study; however, the comparison was made within participants. The\nlower number of participants may have influence the level of statistical significance;\nhowever, power analysis in this study produced a power of 0.998. Moreover, the the use of professional dancers can improve the\nunderstanding researchers can have about the exposure these types of performers\nhave during training and performing. <\/p>\n\n\n\n

CONCLUSIONS<\/strong><\/p>\n\n\n\n

This study\nidentifies a possible contributing factor to overuse injuries and performance\ninhibition in professional female dancers, which had not been formally\nresearched previously. The study suggests that the condition and integrity of\npointe shoes worn by professional ballet dancers may contribute to overuse and\nacute injuries as well as decrease in performance. This related to the higher sway area while\nperforming with \u201cdead\u201d pointe shoes versus \u201cnew\u201d pointe shoes. Moreover, it is\nimportant to identify at what point a \u201cdead\u201d pointe shoe becomes dangerous for\nthe ballet dancers to train and perform in, as this study has identified higher\nforces exerted while using the \u201cnew\u201d pointe shoe. <\/p>\n\n\n\n

APPLICATIONS IN\nSPORT<\/strong><\/p>\n\n\n\n

These results can be used to further research on the pointe shoes of ballet dancers as well as lead to enhancements in ballet footwear design and development. The identification of the criterion at which the pointe shoe becomes \u201cdead\u201d is important. This may assist in minimizing the prevalence of injuries among ballet dancers, as a result of decrease in pointe shoe integrity. Moreover, the ability to correctly identify \u201cdead\u201d pointe shoes may help ballet dancers to keep their performing level at its best. Professional practitioners should inquire their ballet dancer clients as to the condition of their pointe shoes, just as they would a runner and their sneakers.
<\/p>\n\n\n\n

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11.       Rein\nS, Fabian T, Zwipp H, Rammelt S, and Weindel S. Postural control and functional\nankle stability in professional and amateur dancers. Clin Neurophysiol<\/em> 122: 1602-1610, 2011.<\/p>\n\n\n\n

12.       Reinschmidt\nC and Nigg BM. Current issues in the design of running and court shoes. Sportverletz Sportschaden<\/em> 14: 71-81,\n2000.<\/p>\n\n\n\n

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15.       Steinberg\nN, Siev-Ner I, Peleg S, Dar G, Masharawi Y, Zeev A, and Hershkovitz I. Injuries\nin female dancers aged 8 to 16 years. J\nAthl Train<\/em> 48: 118-123, 2013.<\/p>\n\n\n\n

16.       Walter\nHL, Docherty CL, and Schrader J. Ground reaction forces in ballet dancers\nlanding in flat shoes versus pointe shoes. J\nDance Med Sci<\/em> 15: 61-64, 2011.<\/p>\n","protected":false},"excerpt":{"rendered":"

Authors: Jessica Aquino, MS and Tal Amasay, PhD Corresponding Author: […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"jetpack_publicize_message":"","jetpack_is_tweetstorm":false,"jetpack_publicize_feature_enabled":true,"jetpack_social_options":[]},"categories":[994,898],"tags":[1305,1464,1465],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p4btio-1DQ","jetpack-related-posts":[{"id":1498,"url":"https:\/\/thesportjournal.org\/article\/comparison-of-body-image-perceptions-for-female-competitive-dancers-fitness-cohort-and-non-dancers-in-a-college-population\/","url_meta":{"origin":6314,"position":0},"title":"Comparison of Body Image Perceptions for Female Competitive Dancers, Fitness Cohort, and Non-Dancers in a College Population","date":"January 24, 2014","format":false,"excerpt":"Submitted by Lorraine Killion, Ed.D. & Dean Culpepper, Ph.D. ABSTRACT Body image is a complex synthesis of psychophysical elements that are perpetual, emotional, cognitive, and kinesthetic (1). The desire to achieve and maintain an ideal weight is a prevalent goal among females. The purpose of this study was to examine\u2026","rel":"","context":"In "Contemporary Sports Issues"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":498,"url":"https:\/\/thesportjournal.org\/article\/a-comparison-of-body-image-perceptions-for-female-competitive-dancers-fitness-cohort-and-non-dancers-in-a-college-population\/","url_meta":{"origin":6314,"position":1},"title":"A Comparison of Body Image Perceptions for Female Competitive Dancers, Fitness Cohort, and Non-Dancers in a College Population","date":"August 22, 2013","format":false,"excerpt":"ABSTRACT","rel":"","context":"In "Contemporary Sports Issues"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":149,"url":"https:\/\/thesportjournal.org\/article\/plyometrics-or-jump-training-for-dancers\/","url_meta":{"origin":6314,"position":2},"title":"Plyometrics, or Jump Training for Dancers","date":"February 22, 2008","format":false,"excerpt":"Submitted by: Brenda G. Griner, B.S., Douglas Boatwright, Ph.D. and Douglas Boatwright, Ph.D. Introduction One question that many dancers ask is, \u201cHow can I get my jumps higher?\u201d The repetitive execution of demi-plie is used to improve timing, alignment, strength, torso stability, coordination of joint movement, and finally, as a\u2026","rel":"","context":"In "Sports Coaching"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":8084,"url":"https:\/\/thesportjournal.org\/article\/use-of-wrist-guards-for-gymnasts-a-systematic-review\/","url_meta":{"origin":6314,"position":3},"title":"Use of Wrist Guards for Gymnasts \u2013 A Systematic Review","date":"December 10, 2021","format":false,"excerpt":"Authors: Stephanie Choo1,3, Patrick Smith2, and James L. Cook1,3 1University of Missouri Department of Orthopaedic Surgery, Columbia, MO, USA2Columbia Orthopaedic Group, Columbia, MO, USA3Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA Corresponding Author:James L. Cook, DVM, PhD, OTSCWilliam & Kathryn Allen Distinguished Chair in Orthopaedic SurgeryDirector, Thompson\u2026","rel":"","context":"In "Sports Health & Fitness"","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/thesportjournal.org\/wp-content\/uploads\/2021\/11\/Cook-Figure-1.jpg?resize=350%2C200&ssl=1","width":350,"height":200},"classes":[]},{"id":7522,"url":"https:\/\/thesportjournal.org\/article\/ncaa-head-coach-satisfaction-with-athletic-trainers-influence-of-individual-athletic-trainer-characteristics-and-team-factors\/","url_meta":{"origin":6314,"position":4},"title":"NCAA Head Coach Satisfaction with Athletic Trainers: Influence of Individual Athletic Trainer Characteristics and Team Factors","date":"November 13, 2020","format":false,"excerpt":"Authors: Whitney Larson, M.S., ATC, Alyson Dearie, Ed.D., ATC, Larissa True, Ph.D., Brian Richardson, Ph.D., and Erik Lind, Ph.D. Corresponding Author:Erik Lind, Ph.D.1151 Professional Studies BuildingKinesiology DepartmentState University of New York at CortlandCortland, NY 13045erik.lind@cortland.edu(607) 753-2189 Whitney Larson is an assistant athletic trainer with the Iona College Athletic Department in\u2026","rel":"","context":"In "Sports Coaching"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":135,"url":"https:\/\/thesportjournal.org\/article\/job-satisfaction-among-athletic-trainers-in-ncaa-division-i-aa-institutions\/","url_meta":{"origin":6314,"position":5},"title":"Job Satisfaction Among Athletic Trainers in NCAA Division I-AA Institutions","date":"February 15, 2008","format":false,"excerpt":"Submitted by: Roberto Herrera, Ed.D., Department of Health Promotion and Human Performance, Weber State University Jon YeanSub Lim, Ed.D., Department of Health and Physical Education, Northern State University Abstract The purpose of this study was to analyze job satisfaction levels of certified athletic trainers in selected NCAA Division IAA institutions\u2026","rel":"","context":"In "Contemporary Sports Issues"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]}],"_links":{"self":[{"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/posts\/6314"}],"collection":[{"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/comments?post=6314"}],"version-history":[{"count":2,"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/posts\/6314\/revisions"}],"predecessor-version":[{"id":6320,"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/posts\/6314\/revisions\/6320"}],"wp:attachment":[{"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/media?parent=6314"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/categories?post=6314"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/tags?post=6314"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}