Neuromuscular Warm-Up is Associated with Fewer Overuse Injuries in Ballet Dancers Compared to Traditional Ballet-Specific Warm-Up

Neuromuscular warm-up exercises (NMWU) have been shown to prevent injuries. In dance, research on warming-up is scarce. We investigated warm-up habits among ballet dancers and the effects of NMWU and traditional ballet-specific warm-up (TBSWU) on injuries. Using a cross-sectional survey among ballet dancers over the age of 18 years, we recorded acute and overuse injuries sustained in the previous 2 years. Warm-up behavior was assessed through 28 items. Dancers were grouped into NMWU or TBSWU: NMWU was based on neuromuscular warm-up programs in sports science and included exercises improving strength, power, proprioception, sensorimotor control, or cardiovascular stimulus; and TBSWU consisted of stretching, dance-technical exercises, marking steps and running-through-choreographies, or stretching with tools. Separate linear regression analyses adjusted for confounding factors were performed for acute and overuse injuries. A total of 192 dancers (26.7 +/- 7.82 years, 159 females, 132 professionals) reported 203 acute and 469 overuse injuries. In total, 47.4% of dancers always warmed up (mean duration 20.7 +/- 13.2 minutes) based on stretching (63%), technical-exercises (58.9%), strength-training (54.7%), and the barre (53.6%); and 9.4% never warmed up. A total of 31 dancers (16.15%) were classified as TBSWU, 16 dancers (8.3%) for NMWU, and 145 dancers did combined exercises. Those in the NMWU group were associated with fewer overuse injuries compared to those in the TBSWU group (beta = -2.34; 95%CI -3.54 to -1.14). No association was found with acute injuries. As in other athletes, NMWU might be protective against overuse injuries in dancers. Large-scale prospective cohort studies are needed to gain more insight into NMWU as a possible component of injury prevention in ballet.