Epidemiology and Management of Ankle Sprain Injuries over Seven Seasons in an elite professional ballet company

Objectives: To investigate the epidemiology and management of ankle ligament sprains over seven seasons in a professional ballet company. Design: Descriptive Epidemiology Study Methods: Medical attention injury, time-loss injury, and exposure data pertaining to 140 professional ballet dancers were prospectively recorded by Chartered Physiotherapists over seven seasons (2015/16–2021/22); a period including the COVID-19 global pandemic. Results: Sixty-nine ankle sprains (46 time-loss) in 45 dancers (32%) were recorded: 51 sprains were classified as grade I, 15 were classified as grade II, and three were classified as grade III; 53 sprains affected only one ligament, whilst 16 were multi-ligament sprains. For time-loss injuries, median time-loss durations varied by grading (I - 31 days, II - 54 days, and III - 147 days) and the number of ligaments affected (one - 31 days, two - 54 days, three - 134 days, four - 137 days), with time-loss ranging from 1 to 188 days. Of the 46 time-loss ankle sprains, eight were mild, nine were moderate, and 29 were severe. The incidence rate (injuries·1000 h-1) of medical attention ankle sprains was 0.073 (95% CI: 0.046 to 0.117) in male dancers and 0.101 (95% CI: 0.069 to 0.148) in female dancers, and the incidence of time-loss ankle sprains was 0.044 (95% CI: 0.024 to 0.080) in male dancers and 0.064 (95% CI: 0.040 to 0.103) in female dancers. No significant effect of sex was observed on either medical attention (p = .304) or time-loss (p = .327) ankle sprain incidence rates. Ten percent of dancers sustained multiple sprains across the seven seasons. Fifty and 39% of ankle sprains in female and male dancers, respectively, were preceded by a history of ankle sprains. Jumping and landing (30 sprains) and non-dance movements (16 sprains) were the most common inciting movements. Bone bruising and synovitis were the most common concurrent pathologies. Conclusions: Ankle sprains placed a considerable burden on the ballet company studied. These time-loss durations specified by number and grade of ligament sprain, injury history, and secondary pathologies can guide return-to-dance rehabilitation pathways.