The Effect of Training on Hemodynamic Factors in Ballet Dancer

The Effect of Ballet Training on Plantar Venous Pump Activity in Ballerinas

Classic ballet dance is a demonstration of complex motor skills to be revealed in aesthetic combinations and repetitively, and it demands intensive use of the lower extremities within extreme of range of motion (ROM). Because ballet practice depends on advanced technical skills, it involves intensive physical training and causes an overload on the musculoskeletal system and foot deformities such as pes planus.

Plantar venous pump (PVP) is a network of multiple venous vessels located between the muscles of the foot arch. PVP is considered the first step of venous return and discharges into the posterior tibial vein (PTV). PVP is reported to be active during gait while it is inactive in resting position. There are different views on the mechanisms enabling its activation 1-3. The general view is that during the stance phase of the gait, the flattening of the plantar arch with weight transfer causes the veins in this region to narrow and creates a force that pumps the blood up.

The aim of this study is the investigation what kind of hemodynamic changes ballet training causes in the lower extremity

Study Overview

• Status: Completed
• Conditions: Venous Insufficiency; Foot Drop (Acquired)
• Intervention / Treatment: Other: Navicular drop measurement; Other: Measurement of venous return parameters in supine; Other: Measurement of venous return parameters in standing; Other: measurement of midfoot pressure distrubition

• Study Type: Observational
• Enrollment (Actual): 28

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey, 34000
    • Marmara University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 19 years (ADULT, CHILD)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

• Sampling Method: Probability Sample

Study Population

Ballerinas taking ballet training at least for 4 years and female sedentary students

Description

Inclusion Criteria (for balerinas):

• receiving ballet training at least 10 h per week for at least 4 years
• receiving formal dancing training system

Inclusion Criteria (for non-dancer group)

• never receiving formal dancing training
• having sedentary lifestyle

Exclusion Criteria:

• Participants with a history of foot or ankle surgery,
• Participants with connective tissue disease,
• Participants with rigid pes planus-cavus,
• Participants with chronic venous insufficiency
• Participants with acute ankle injury in recent 3 months

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Ballerinas; Balerina students who have trained at least for 4 years	Other: Navicular drop measurement; The difference in navicular height between sitting and standing positions was recorded (mm) as the amount of navicular drop.; Other: Measurement of venous return parameters in supine; Venous return parameters of posterior tibial vein was measured when participant applied force equivalent to their own body weight on plantar surface of their right leg in supine position; Other: Measurement of venous return parameters in standing; In standing, venous return parameters was measured of posterior tibial vein when participants shift all of their weight to the right leg for 3 second with their leg muscles as relaxed as possible and their knee joint in full extension.; Other: measurement of midfoot pressure distrubition; In standing, midfoot pressure distrubution was measured when participants shift all of their weight to the right leg
Female students; Female students with sedentary lifestyle	Other: Navicular drop measurement; The difference in navicular height between sitting and standing positions was recorded (mm) as the amount of navicular drop.; Other: Measurement of venous return parameters in supine; Venous return parameters of posterior tibial vein was measured when participant applied force equivalent to their own body weight on plantar surface of their right leg in supine position; Other: Measurement of venous return parameters in standing; In standing, venous return parameters was measured of posterior tibial vein when participants shift all of their weight to the right leg for 3 second with their leg muscles as relaxed as possible and their knee joint in full extension.; Other: measurement of midfoot pressure distrubition; In standing, midfoot pressure distrubution was measured when participants shift all of their weight to the right leg

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Evaluation of navicular drop	Navicular drop was measured in mm	Cchange from baseline navicular height in pre-intervention and immediately after the intervention/
Evaluation of diameter of tibialis posterior vein in supine	Diameter of tibialis posterior vein was measured in mm	Change from baseline diameter of tibialis posterior vein during intervention
Evaluation of flow velocity of tibialis posterior vein in supine	Flow velocity of tibialis posterior vein was measured in cm/s	Change from baseline flow velocity of tibialis posterior vein during intervention
Evaluation of volume flow of tibialis posterior vein in supine	Volume flow of tibialis posterior vein was measured in ml/min	Change from baseline volume flow of tibialis posterior vein during intervention
Evaluation of diameter of tibialis posterior vein during weight bearing	Diameter of tibialis posterior vein was measured in mm	Change from baseline diameter of tibialis posterior during intervention
Evaluation of flow velocity of tibialis posterior vein during weight bearing	Flow velocity of tibialis posterior vein was measured in cm/s	Change from baseline flow velocity of tibialis posterior vein during intervention
Evaluation of volume flow of tibialis posterior vein during weight bearing	Volume flow of tibialis posterior vein was measured in ml/min	Change from baseline volume flow of tibialis posterior vein during intervention
Evaluation of midfoot plantar pressure during weight bearing	Midfoot plantar pressure was measured in gr/cm2	Change from baseline midfoot pressure during intervention

Collaborators and Investigators

• Sponsor: Marmara University
• Investigators: Principal Investigator: Nilüfer Kablan, PhD, Marmara University

Publications and helpful links

General Publications

• Guss-West C, Wulf G. Attentional Focus in Classical Ballet: A Survey Of Professional Dancers. J Dance Med Sci. 2016 Mar;20(1):23-9. doi: 10.12678/1089-313X.20.1.23.
• Allen N, Nevill A, Brooks J, Koutedakis Y, Wyon M. Ballet injuries: injury incidence and severity over 1 year. J Orthop Sports Phys Ther. 2012 Sep;42(9):781-90. doi: 10.2519/jospt.2012.3893. Epub 2012 Jul 19.
• Gardner AM, Fox RH. The venous pump of the human foot--preliminary report. Bristol Med Chir J. 1983 Jul;98(367):109-12. No abstract available.
• Kim TI, Forbang NI, Criqui MH, Allison MA. Association of foot and ankle characteristics with progression of venous disease. Vasc Med. 2015 Apr;20(2):105-11. doi: 10.1177/1358863X14568443.
• Pearson SJ, Whitaker AF. Footwear in classical ballet: a study of pressure distribution and related foot injury in the adolescent dancer. J Dance Med Sci. 2012;16(2):51-6.
• Khan K, Brown J, Way S, Vass N, Crichton K, Alexander R, Baxter A, Butler M, Wark J. Overuse injuries in classical ballet. Sports Med. 1995 May;19(5):341-57. doi: 10.2165/00007256-199519050-00004.

Study record dates

Study Major Dates

• Study Start (ACTUAL): September 4, 2017
• Primary Completion (ACTUAL): November 3, 2017
• Study Completion (ACTUAL): January 5, 2018

Study Registration Dates

• First Submitted: July 2, 2020
• First Submitted That Met QC Criteria: July 8, 2020
• First Posted (ACTUAL): July 14, 2020

Study Record Updates

• Last Update Posted (ACTUAL): July 14, 2020
• Last Update Submitted That Met QC Criteria: July 8, 2020
• Last Verified: February 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Nervous System Diseases; Neuromuscular Diseases; Mononeuropathies; Peripheral Nervous System Diseases; Venous Insufficiency; Peroneal Neuropathies
• Other Study ID Numbers: 09.2017.129

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No