A Participatory Action Research Approach to Develop Bone Stress Injury Prevention Strategies in Classical Ballet

Objectives: Bone stress injuries (BSI) result in lengthy rehabilitation periods for professional and pre-professional ballet dancers. For dancers who sustain BSI, there is a high chance of recurrence, which may affect future dance participation and career opportunities. This research engaged stakeholders from a classical ballet company to co-create BSI prevention strategies. Design: Participatory action research. Methods: Stakeholder-researchers (n = 17) within a professional ballet company participated in four sequential focus group meetings. Their roles included: Artistic staff, current/former dancers, clinicians, community engagement, events, marketing, facilities management, and philanthropy. Meetings were recorded, transcribed, and coded thematically. Finally, the group drafted a BSI prevention proposal for the organisation. Results: Stakeholder-researchers felt improving health literacy for recreational dancers in the community was important, as there may be an onflow of poor health behaviours from the community level into to pre-professional and professional settings. Priorities for prevention in the professional setting were improving access to onsite health services, annual health evaluations, refining safeguarding policies, and investigating wearable technology. Priorities for the community included targeted BSI education for dancers, teachers, and families. The artistic process, poor nutrition, stress, lack of load monitoring strategies, and glorification of dancing despite injury, are barriers to BSI prevention in both professional and community settings. Systemic barriers such as funding, and community access to dance-informed health practitioners were identified. Dancers may not utilise health services for 'athletes', because they identify strongly as artists. Conclusion: Stakeholder-researchers collaborated through PAR to identify and prioritise strategies for BSI prevention. Health literacy surveys and ongoing systematic injury surveillance were recommended to evaluate intervention effects.