Physical Therapy in Sport 33 (2018) 33e39

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Physical Therapy in Sport

journal homepage: www.elsevier.com/ptsp

Original Research

Comparison of lumbopelvic and dynamic stability between dancers

and non-dancers
Alba Paris-Alemany a, b, c, d, g, *, Alba Torres-Palomino a, Lilya Marino a, Ce

sar Calvo-Lobo e,
Luis Gadea-Mateos f, Roy La Touche a, b, c, d
a
noma de Madrid, Madrid, Spain
Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Auto
b
Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle,
Universidad Auto
noma de Madrid, Madrid, Spain
c
Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
d
Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
e
Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de Leo
n, Ponferrada, Leo

n, Spain
f

Conservatorio Superior de Danza María de Avila, Madrid, Spain
g
n, Madrid, Spain
Faculty of Health Science, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorco

a r t i c l e i n f o a b s t r a c t

Article history: Objective: To compare lumbopelvic stability between dancers and non-dancers by assessing lumbopelvic
Received 28 June 2018 motor control, abdominal muscles automatic-activation, lumbar range of motion and dynamic stability.
Accepted 30 June 2018 Design: Cross-sectional.
Setting: University/superior-dance-conservatory.
Keywords: Participants: Twenty-two dancers and 22 non-dancers.
Dancers
Main outcome measurements: The active straight leg raise test (ASLR) was used to test lumbopelvic motor
Stability
control with pressure feedback (mmHg). Transversus, rectus anterior and internal oblique muscles
Ultrasonography
Motor control
thicknesses were measured at rest and ASLR. For dynamic stability, the modified Star Excursion Balance
Test (mSEBT) was employed.
Results: Significant differences were revealed in lumbopelvic motor control between groups (p < 0.001).
Abdominal muscles automatic-activation showed no differences between the groups. There were sig-
nificant differences in the mSEBT for most of the test's directions, with dancers performing better than
the non-dancers (p < 0.05). For the dancers, there were positive associations between motor control and
dynamic stability, and between abdominal muscle thickness and mSEBT. For non-dancers, the rectus
anterior activation correlated with the mSEBT.
Conclusions: The dancers had better lumbopelvic motor control, dynamic stability and lumbar move-
ments except in terms of extension, as compared with non-dancers. Therefore, this novel study could
stimulate a new line of research to determine the influence of these outcomes on sports performance,
prevention and injury rehabilitation.
© 2018 Elsevier Ltd. All rights reserved.

1. Introduction function in daily movements is known to be dependent on the

Lumbopelvic stability has been studied in depth in recent de-
cades due to the high prevalence of low back pain (LBP) among
athletes and dancers (Fett, Trompeter, & Platen, 2017). Spine
* Corresponding author. Departamento de Fisioterapia. Centro superior de estu-

noma de Madrid, INCIMOV, Calle la
dios Universitarios La Salle, Universidad Auto
Salle, 10, (Aravaca), 28023, Madrid, Spain.
E-mail address: alba.paris@gmail.com (A. Paris-Alemany).
stabilization provided by the anticipatory contraction of deep
muscles in the trunk (C. T. V Swain, Bradshaw, Whyte, & Ekegren,
2017). The activation of these trunk muscles must have proper
neuromuscular motor control to permit lumbopelvic stabilization.
In fact, good coordination of the activation of each abdominal
muscle needs to be provided (Bruno, 2014). The transversus
abdominis (TrA), multifidus and internal oblique (IO) muscles
comprise part of the deep stabilizers that lend control and stability
to the spine (Huxel Bliven & Anderson, 2013). The automatic acti-
vation of these muscles provides a belt-like tension to the trunk

https://doi.org/10.1016/j.ptsp.2018.06.010
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34 A. Paris-Alemany et al. / Physical Therapy in Sport 33 (2018) 33e39
that has been defined as the “core” (Kibler, Press, & Sciascia, 2006).
Good core stability is needed to perform movements of the trunk
and extremities correctly, particularly in athletic activities (Kibler
et al., 2006). Other muscles, such as the rectus abdominis (RA),
erector spinae, external oblique and quadratus lumborum comprise
the global stabilizers and allow for larger trunk motions with rapid
and powerful torque (Huxel Bliven & Anderson, 2013). These two
systems (the core and global stabilizers) are involved in the dy-
namic stabilization required to perform the functional demands
related to daily activities, sports and dance (Huxel Bliven &
Anderson, 2013).
Dancers need to achieve difficult technical skills to perform
precise and synchronized combinations of movements, which
involve good motor control of the extremities and core (Kibler et al.,
2006). There is controversy over whether dancers are sufficiently
physically prepared for their training requirements (Rafferty, 2010),
given the high prevalence of injuries, particularly LBP (Jacobs,
Hincapie
, & Cassidy, 2012). A study of modern dancers found
that, over a 12-month period, 17% of the dancers reported a lower
back injury (Shah, Weiss, & Burchette, 2012). Also reduced trunk
muscle endurance has been found among dancers with LBP (C.
Swain & Redding, 2014). A determining factor for the risk of injury
is a lack of postural stability, which refers to the ability to change
the center of gravity position, adapting and varying it according to
the perceived input (Fort Vanmeerhaeghe et al., 2009). In terms of
lumbopelvic stability, studies have shown the importance of
strength, coordination, and endurance, as well as their association
with lower extremity alignment and load assimilation (Roussel
et al., 2012). Improvements in abdominal muscle strength
through core stabilization training lead to improved static and
dynamic balance and spinning ability for pirouettes (Watson et al.,
2017).
The TrA has been described as the main stabilizer of the trunk,
since a lack of TrA motor control and slower activation of the TrA in
patients with chronic LBP has been reported (França, Burke,
Hanada, & Marques, 2010). This explains why the TrA is the prin-
cipal target of most current rehabilitation protocols, which focus on
specific exercises to improve the core's activation and neuromus-
cular motor control (Watson et al., 2017). Due to the multifactorial
nature of lumbopelvic stability and its associated outcomes, various
treatment and evaluation approaches have been studied (Roussel
et al., 2012).
Several reliable instruments have been used to assess muscular
condition and activation, such as magnetic resonance imaging
(MRI), electromyography (EMG) and rehabilitative ultrasound im-
aging (RUSI) (Hides et al., 2006). RUSI is considered a non-invasive,
inexpensive and reliable method of measuring the length and
thickness of the deep muscles (Hodges, Pengel, Herbert, &
Gandevia, 2003). Hodges et al. developed a clinical method to
indirectly evaluate lumbopelvic stability using a pressure biofeed-
back unit (PBU) situated in the low back region to register possible
changes in lumbopelvic position when performing various
movements.
There are many ways to assess dynamic stability. The Star
Excursion Balance Test (mSEBT) is a battery of motion tests in 3
spatial planes, with the aim of functionally or dynamically assess-
ing stability (Kinzey & Armstrong, 1998). Dynamic stability requires
strength, flexibility and proprioception (Bressel, Yonker, Kras, &
Heath, 2007).
Thus, the aim of this study was to compare the lumbopelvic
motor control of dancers and non-dancers. The second aim was to
analyze the dynamic stability, automatic abdominal muscle acti-
vation and low back range of motion (LBROM). We also analyzed
possible associations between the outcomes.
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2. Methods
2.1. Experimental approach to the problem
The study had a transversal observational design, and the
sample consisted of volunteers from the local community of the La

noma de Madrid
Salle Center of Higher Education Universidad Auto


and the Superior Dance Conservatory of María de Avila, Madrid. We
hypothesized that dancers would have greater lumbopelvic motor
control than non-dancers. Therefore, the dynamic stability, auto-
matic abdominal muscle activation and LBROM were compared
between dancers and non-dancers.
2.2. Subjects
A consecutive convenience sample was recruited from February
2017 to May 2017. The inclusion criteria were healthy subjects be-
tween 18 and 55 years of age (Hagstromer, Oja, & Sjostrom, 2006).
The exclusion criteria were participants with a history of surgery
and/or pregnancy during the last year; musculoskeletal or osteo-
ligamentous injury in the last 6 months associated with immobi-
lization, rest or reductions in daily exercise or fitness activities for
more than 4 weeks; severe pain in the last 4 weeks that stopped
physical activity; and hyperventilation syndrome as assessed with
the Nijmegen questionnaire (a score of 23 points or greater out of
64) (Van Dixhoorn & Duivenvoorden, 1985).
The local ethics committee approved the research, which com-
plied with the Helsinki declaration. A signed informed consent
document was required to participate in the study. The participants
were divided into two groups: professional or semi-professional
dancers and non-dancer participants comprised the dance group
(DG) and non-dance group (NDG), respectively.
After confirming that they met the inclusion criteria and none of
the exclusion criteria, the participants proceeded to the assess-
ment. On the day of the assessment, we collected demographic
data, and the International Physical Activity Questionnaire (IPAQ)
and Nijmegen questionnaires were filled out. The IPAQ was used to
analyze the participants' physical activity levels, calculating the
metabolic equivalents of the task (METs) per minute per week,
categorizing the METs as low activity (sedentary), moderate or
vigorous. Values less than 1500 METs/min/week were considered a
moderate level of activity, and 1500 METs or more were considered
a vigorous level of activity. Appropriate psychometric properties
have been shown for this questionnaire (Craig et al., 2003).
2.3. Procedures
2.3.1. Lumbopelvic motor control
A Chattanooga Stabilizer™ (Chattanooga Group Inc, Hixson,
USA) device was employed to measure lumbopelvic stability, given
that previous studies have used this device (Richardson, 1993;
Roussel et al., 2012). The stabilizer is a pressure biofeedback unit
(PBU) that, when placed on the low back region, provides reliable
indirect measures (Azevedo et al., 2013) of the degree of lumbo-
pelvic stabilization and activation of the deep abdominal muscles
by recording pressure changes that occur while performing lower
extremity movements. The stabilizer's plastic pillow was placed
horizontally on the lower back region, at the intersection of the
inferior border and the posterior superior iliac spine (Comerford,
1992). The PBU measures pressure changes of 2 mm Hg, with the
initial pressure set at 40 mm Hg (Azevedo et al., 2013).
The supine active straight leg raise test (ASLR) was selected to
measure pressure changes. The highest pressure reached while
performing the ASLR was recorded (positive or negative). The
participant was placed in a supine position with the legs extended
 A. Paris-Alemany et al. / Physical Therapy in Sport 33 (2018) 33e39
and the arms resting alongside the body. The ASLR was always
performed with the right leg, while the left leg was held in the
initial position. Participants were required to perform a 20-cm
elevation of the right leg with the knee extended, following the
Liebenson, Karpowicz, Brown, Howarth, and Mcgill (2009) protocol
(Liebenson et al., 2009).
2.3.2. Automatic activation of abdominal muscles
Automatic activation of the abdominal muscles was analyzed by
measuring the thickness of the abdominal muscles with the
Whittaker et al. RUSI protocol (Whittaker, Warner, & Stokes, 2013).
A portable ultrasound (GE Healthcare LOGIQ Book XP-R2.1.5) and a
linear probe (8L-RS Wide Band Linear Probe, 2333880 model
number; 14.2
47-mm footprint) with a frequency range of
4e12 MHz were used to perform resting B-mode evaluations at the
end of a relaxed expiration. The measured outcomes were the
thickness of RA, IO and TrA on the right side while in the supine
position. Each muscle was measured 3 times (the final measure
being the mean of the 3 measurements) while at rest and while
performing the ASLR. The ASLR was maintained for 5 s, ensuring
that the measurements were performed at the end of the relaxed
exhalation (Whittaker et al., 2013). The first set of measurements
was performed at the RA, placing the probe transversally to the
right of the belly button and recording the distance between the
superior and inferior fascia (Whittaker et al., 2013). Next, the
thickness of the TrA and IO was measured, placing the probe
transversally at the medial point between the iliac crest and the
costal border at the axillary line (Whittaker et al., 2013). This view
offers an image of all 3 abdominal muscles. The thickness of the TrA
and IO was measured systematically 2 cm from the anterior fascia
of the TrA (Ferreira, Ferreira, & Hodges, 2004). RUSI has been shown
to be reliable and comparable to MRI (intraclass correlation coef-
ficient (ICC) 0.78e0.95) (Hides et al., 2006; Hodges et al., 2003).
2.3.3. Dynamic stability
Dynamic lumbopelvic stability and balance were measured in
the standing position using the modified Star Excursion Balance
Test (mSEBT) (Coughlan, Fullam, Delahunt, Gissane, & Caulfield,
2012) to assess physical performance and determine potentially
reduced dynamic postural control (Plisky, Gorman, Butler, Kiesel, &
Underwood, 2009). In the mSEBT, the participant stands on one leg
while performing various movements with the other leg. The goal
is to reach as far as possible with the raise leg (Kinzey & Armstrong,
1998). Before the participant begins, 3 strips of tape measuring
1.5 m each are placed on the floor to form an inverted Y shape (with
an anterior arm and posteromedial and posterolateral arms placed
135 to the anterior arm). The participant stands in the center
facing the anterior arm and performs first the anterior and then the
posterolateral and posteromedial movements. The measurements
are performed with the participant shoeless (Gribble & Hertel,
2003). The distance reached in the 3 correctly performed move-
ments for each direction is recorded (Plisky, Mitchell, & Kaminski,
2006). A movement is considered incorrect if the participant does
not return to the initial position with the feet together or if they
moved or lifted the foot on which they are standing. If incorrect, the
movement is repeated (Plisky et al., 2009). The movements were
first performed by the researcher, and each participant performed 4
practice movements with each leg in each test direction (Coughlan
et al., 2012; Plisky et al., 2006). After 2 min of rest, the participant
begun the actual test. The mSEBT has a standardized protocol and
excellent reliability (ICC 0.85e1.00) (Plisky et al., 2009). The mini-
mal detectable change has been reported as 5.5 cm for anterior,
7.5 cm for posteromedial and 9.7 cm for posterolateral movements
(Shaffer et al., 2015).
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35
2.3.4. Low back range of motion
LBROM was measured during trunk flexion and lateral flexion.
We employed a smartphone inclinometer application that has been
validated and tested with good reliability (Pourahmadi et al., 2016).
These measurements were made by placing the base of the mobile
phone on the patient's twelfth thoracic vertebra (T12) while in the
standing position. The patient was asked to perform a forward
flexion of the trunk. The process was repeated by placing the mo-
bile phone on the S2 vertebra. The measurement was then sub-
tracted from the previous results, obtaining the lumbar flexion
data. For the extension movement, the device was placed at T12,
and the initial value was subtracted from the final extension result.
The lateral flexion movements were measured by placing the de-
vice flat on the back at T9eT12, with the base facing the lateral
flexion side (Kolber, Mdt, Pizzini, Robinson, & Yanez, 2013). Before
the range of motion (ROM) assessment, the participants were
instructed to perform a short warm-up by performing left and right
rotations of the lumbar spine for 2 min.
2.3.5. Replication of the study
The RUSI measurements were collected at rest and then during
ASLR. Motor control was then measured by the PBU during ASLR.
Lastly, dynamic stability was measured with the mSEBT. For each of
the outcomes, 3 repetitions were performed, and their means were
used for the analysis. If the movement was poorly executed, the
measurement was repeated.
2.4. Statistical analyses
The sample size was calculated to detect differences between
the 2 groups regarding the primary variables. A statistical power of
95% (1-b) with a probability error level a of 0.05 was used. A Stu-
dent's t-test was considered for independent samples with an effect
size of 0.77. The calculation suggested a sample of 44 participants.
The software employed was G * Power 3.1 for Mac (G * Power©,
Dusseldorf University. Germany). The significance level for all sta-
tistics was established at p < 0.05.
The analysis was performed with the Statistical Package for
Social Sciences (SPSS) version 22. The normality of the variables
was determined with the Shapiro-Wilk test. Parametric tests were
applied for the statistical analysis. The demographic data are pre-
sented as mean and standard deviation (SD) for the continuous
variables and frequency (%) for the categorical variables.
The effect size was calculated with Cohen's method (d) and was
considered a small (0.20e0.49), medium (0.50e0.79) or large effect
size (>0.8) (Kelley & Preacher, 2012). For the intergroup compari-
sons, Student's t-test was used. For the analysis of the associations,
we performed a Pearson correlation test. The correlations were
considered to be moderate from 0.4 to 0.7, strong from 0.7 to 0.85
and very strong greater than 0.85 (Sedgwick, 2012).
3. Results
A total of 44 participants were included in the study. Each group
was composed of 22 participants (dancers and non-dancers). Both
groups were similar in terms of age and body mass index (Table 1).
Each group scored less than 23 points on the Nijmegen question-
naire, and there were statistically significant differences between
the groups. The IPAQ results indicated a high level of activity for the
DG (14083 METs) and a moderate level of activity for the NDG
(1198.27 METs). Dancers from various types of dance were included
in the DG: 27.27% from ballet, 22.72% from contemporary dance,
22.27% from Spanish dance, and 27.27% from Flamenco.
36 A. Paris-Alemany et al. / Physical Therapy in Sport 33 (2018) 33e39

Table 1 variable.
Descriptive data.

Outcomes DG (n ¼ 22) NDG (n ¼ 22) p-value

3.2.2. Motor control versus dynamic stability correlations
Age (years) 24.05 ± 5.744 24.27 ± 5.783 0.89
BMI (kg/m2) 20.30 ± 1.51 21.45 ± 2.25 0.054 The “r” values for the Pearson correlations are presented in
Gender Table 3. The analyses showed a moderate association between the
Females 19 (86.36) 15 (68.18) Stabilizer outcome and all mSEBT measures (p < 0.05), except for
Males 3 (13.64) 7 (31.82)
the posterolateral movement with the left leg and only in the DG.
Questionnaires
Nijmegen 13.14 ± 5.12 6.95 ± 4.16 0.001
IPAQ (METS) 14083.64 ± 4986.38 1198.27 ± 586.49 0.001
3.2.3. Automatic abdominal muscle activation versus dynamic
Abbreviations: DG: Dancers group, NDG: Non-dancers group, BMI: Body Mass In-
dex, IPAQ: The International Physical Activity Questionnaire, METS: Metabolic stability correlations
Equivalent of Task. In the DG, a moderate association was found between RA
thickness at rest and posterolateral movement of the mSEBT with
both legs, as well as between RA thickness during ASLR and
3.1. Intergroup comparisons posterolateral with both legs and posteromedial with the left leg
(p < 0.05). The IO thickness at rest and during ASLR also showed a
The results of the Student's t-test for all analyzed variables are moderate association with mSEBT during posterolateral and post-
presented in Table 2. There were statistically significant differences eromedial movements with the right leg and during posterolateral
between the 2 groups for motor control (p < 0.001), with a large movements with the left leg (p < 0.05).
effect size and lower values obtained by the DG. In terms of In the NDG, correlations were obtained between RA thickness at
abdominal muscle thickness, there were no differences between rest and most of the mSEBT movements, with moderate associa-
the 2 groups for any of the performed measurements. tions (p < 0.05), except for the posterolateral right leg mSEBT
Regarding the dynamic stabilization outcomes, there were sig- movement, which had a strong association with the RA thickness at
nificant differences for 3 of the measures with a moderate effect rest and ASLR (p < 0.001).
size, with higher values in the DG when performing the anterior
and posterolateral movements with the right leg and the anterior
movement with the left leg (p < 0.05). 4. Discussion
There were statistically significant differences between the 2
groups for all LBROM (p < 0.05) measurements except for exten- The results of this study confirm the principal hypothesis, given
sion, with higher values in the DG. The effect sizes were large for that the dancers achieved better results for lumbopelvic motor
flexion and left lateral flexion and moderate for right lateral flexion. control than the non-dancers. The second hypothesis was partially
confirmed; the dancers demonstrated better dynamic stability and
3.2. Correlations LBROM in most of the measures. However, the null hypothesis was
confirmed regarding activation of the abdominal muscles, given
3.2.1. Low back range of motion correlations that there were no differences between the dancers and non-
No associations were found between LBROM and any other dancers.

Table 2
Between groups comparisons.

Outcomes DG NDG Mean difference (95% CI) t Effect size (Cohen's d)

Stabilizer (mmHg) SLR 39.41 ± 2.51 47.65 ± 7.85 8.25 (- 11.79 to 4.70)** 4.69 1.4

USI (cm)
Muscle distance RA Rest 0.57 ± 0.31 0.47 ± 0.29 0.10 (0.08 to 0.29) 1.10 0.33
RA SLR 0.64 ± 0.29 0.53 ± 0.30 0.10 (0.08 to 0.28) 1.13 0.37

Muscle thickness RA Rest 0.92 ± 0.15 1.04 ± 0.26 - 0.12 (- 0.25 a 0.01) - 1.83 0.56
RA SLR 0.98 ± 0.16 1.09 ± 0.28 - 0.11 (- 0.25 a 0.03) 1.54 0.48
TrA Rest 0.33 ± 0.10 0.36 ± 0.11 0.03 (- 0.09 a 0.03) 0.95 0.28
TrA SLR 0.44 ± 0.16 0.46 ± 0.14 0.02 (- 0.11 a 0.07) 0.42 0.13
OI Rest 0.70 ± 0.20 0.73 ± 0.20 0.03 (- 0.15 a 0.09) 0.54 0.15
OI SLR 0.71 ± 0.21 0.80 ± 0.23 0.08 (- 0.22 a 0.05) 1.22 0.4
mSEBT (cm)
mSEBT RA 66.68 ± 5.26 63.04 ± 6.51 3.63 (7.23 a 0.04)* 2.04 0.61
mSEBT R PM 90.60 ± 12.10 87.37 ± 8.34 3.23 (- 2.84 a 9.31) 1.07 0.3
mSEBT R PL 90.36 ± 12.10 82.99 ± 8.57 7.37 (0.99 a 13.75)* 2.33 0.70
mSEBT LA 66.48 ± 5.39 61.81 ± 6.80 4.66 (8.40 a 0.93)* 2.52 0.76
mSEBT L PM 92.31 ± 12.18 87.50 ± 9.74 4.80 (- 1.91 a 11.51) 1.44 0.43
mSEBT L PL 88.25 ± 14.25 85.75 ± 9.01 2.50 (- 4.75 a 9.76) 0.70 0.21
ROM ( )
LB Flex 104.51 ± 11.81 63.75 ± 13.04 33.04 (24.03e42.06)* 10.86 3.27
TLB Flex 126.83 ± 16.21 93.79 ± 13.27 40.75 (33.18e48.32)* 7.40 2.23
Extension 33.10 ± 11.64 31.65 ± 10.87 1,44 (5.41 to 8.30) 0.43 0.13
R Lat Flex 26.62 ± 7.30 22.04 ± 5.00 4.57 (0.77e8.38)* 2.43 0.73
L Lat Flex 27.39 ± 5.43 20.62 ± 5.36 6.77 (3.49e10.06)* 4.16 1.25

Abbreviations: DG: Dancers group, NDG: Non-dancers group, USI: Ultrasound imaging; RA: Rectus abdominis muscle, SLR: Straight Leg Raise, TrA: Transverse muscle, IO:
Internal oblique, mSEBT: Modified Star Excursion Balance Test, R: Right, A: Anterior, PM: Posteromedial, PL: Posterolateral, L: Left, ROM: Range of motion, LB Flex: Low back
flexion, TLB Flex: Thoracolumbar flexion, Lat Flex: Lateral flexion, mmHg: Millimeters of mercury, cm: Centimeters,  : Degrees. *p value < 0.05; **p value < 0.001.

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 A. Paris-Alemany et al. / Physical Therapy in Sport 33 (2018) 33e39 37

Table 3
Correlations between motor control, dynamic stability and muscle activation.

Outcomes Groups Stabilizer SLR mSEBT R A mSEBT R PM mSEBT R PL mSEBT L A mSEBT L PM mSEBT L PL

Stabilizer SLR DG 0.53* 0.51* 0.43* 0.51* 0.47* 0.36

NDG 0.01 0.11 0.06 0.14 0.1 0.03
RA Rest DG 0.13 0.24 0.34 0.43* 0.27 0.40 0.46*
NDG 0.09 0.26 0.52* 0.70** 0.07 0.57** 0.46*
RA SLR DG 0.02 0.26 0.40 0.45* 0.20 0.44* 0.45*
NDG 0.31 0.24 0.38 0.61** 0.01 0.46* 0.29
TrA Rest DG 0.02 0.16 0.20 0.16 0.10 0.14 0.07
NDG 0.00 0.07 0.01 0.03 0.10 0.01 0.06
TrA SLR DG 0.13 0.15 0.20 0.13 0.08 0.09 0.14
NDG 0.07 0.29 0.16 0.20 0.28 0.26 0.22
IO Rest DG 0.09 0.14 0.53* 0.44* 0.30 0.41 0.44*
NDG 0.32 0.39 0.22 0.38 0.28 0.30 0.21
IO SLR DG 0.25 -s0.01 0.43* 0.44* 0.17 0.36 0.46*
NDG 0.06 0.34 0.30 0.29 0.14 0.19 0.27

Abbreviations: DG: Dancers group, NDG: Non-dancers group, US: Ultrasound imaging; RA: Rectus abdominis muscle, SLR: Straight Leg Raise, TrA: Transverse muscle, IO:
Internal oblique, mSEBT: Modified Star Excursion Balance Test, R: Right, A: Anterior, PM: Posteromedial, PL: Posterolateral, L: Left, ROM: Range of motion, LB Flex: Low back
flexion, TLB Flex: Thoracolumbar flexion, Lat Flex: Lateral flexion, mmHg: Millimeter of mercury, cm: Centimeters,  : Degrees*p value < 0.05; **p value < 0.001.

4.1. Lumbopelvic motor control and automatic activation of flexibility and neuromuscular coordination, in addition to muscular
abdominal muscles thickness. It is possible that dancers' lumbopelvic motor control is
supported by multiple factors. Lederman proposed a motion con-
Abdominal muscle thickness was measured at rest and during trol model that could explain dancers' dynamic stability and lum-
an active movement. RUSI reveals the features of the abdominal bopelvic motor control and suggested that movement motor
wall muscles, showing the changes in RA, IO, EO and TrA through control depends on various underlying factors including strength,
the measurement of each muscle's thickness, regardless of the velocity, endurance and the synergic control and coordination of
lateral dominance or the measured side (Whittaker et al., 2013). co-contractions and reciprocal neuromuscular activation
The studies that compared LBP and healthy participants at rest (Lederman, 2010). All of these factors act together; if there is any
found similar results for muscles thicknesses (0.91 ± 0.12 cm for disorder or if any of the factors are modified, the movement motor
RA; 0.25 ± 0.05 cm for TrA; 0.55 ± 0.7 cm for IO) (Whittaker et al., control will be affected (Lederman, 2010).
2013).
In view of our results, we hypothesize that dancers present a
4.2. Dynamic stability & LBROM
different neuromuscular strategy for maintaining lumbopelvic
motor control than that of non-dancers. This strategy would not be
Originally, the dynamic stability test was conducted in 8 di-
exclusively dependent on the neuromuscular activity of the
rections (SEBT); however, a number of studies have employed a
abdominal muscles. A critical analysis of the evidence (Lederman,
modified version (mSEBT) with only 3 directions: anterior, post-
2010) called into question the lumbopelvic control motor model
eromedial and posterolateral (Plisky et al., 2009). Both tests involve
based on the two subsystems theory (global and local stabilization).
similar movements that have been validated to measure balance
Lederman suggested that the model was too reductionist to explain
and dynamic stability (Coughlan et al., 2012).
motor control and that local neuromuscular deficits could be pre-
Ambegaonkar et al. found that dancers had higher dynamic
sent in people with adequate stability and would not necessarily be
stability scores than non-dancers, with significantly greater dis-
indicative of pathology. Previous findings have suggested that only
tances in the posteromedial direction. Dancers obtained a mean of
slight abdominal muscle activation is needed to maintain adequate
92.6 ± 5.6 cm with the right leg (p ¼ 0.01), while no-dancers
stability. A study by Kibler et al. reported 5% maximum voluntary
reached 87.0 ± 6.4 cm (Ambegaonkar et al., 2012). Our study
contraction for daily activities, 10% for high physical demand ac-
found similar results, which could be related to the intrinsic
tivities (Kibler et al., 2006). Gildea et al. found that TrA and IO
movement of dance, which results in the continuous need for
thickness did not differ between dancers with or without lumbo-
similar dynamic stability strategies as needed for the SEBT.
pelvic pain; however, the authors found an asymmetric contraction
Bressel et al. investigated dynamic stability with the SEBT in
pattern (Gildea, Hides, & Hodges, 2014).
various sports, concluding that basketball players have lower SEBT
Evidence has suggested that lumbopelvic motor control can be
scores compared with soccer players and gymnasts (Bressel et al.,
assessed with the PBU while evaluating TrA muscle activity in
2007). It would be interesting in future research to compare the
healthy individuals and individuals with a history of pain (Garnier
results between dance disciplines to establish which type of dance
et al., 2009; Lima et al., 2012), despite the fact that multiple
has greater stability requirements and to plan training strategies to
neuromuscular strategies could be involved in maintaining lum-
meet these requirements.
bopelvic motor control during the test.
Our results suggest the presence of positive moderate to sig-
Professional dancing requires significant physical effort, and the
nificant associations between RA thickness and dynamic stability in
specificity of the practice leads to certain physiological adaptations;
most directions in the DG and NDG. Regarding IO thickness, we
for example, the evidence suggests that postural control and dy-
found positive moderate associations with some dynamic stability
namic stability are dependent on visual information (Muelas Pe
rez,
measures.
Sabido Solana, Barbado Murillo, & Moreno Herna
ndez, 2014). For
The LBROM results indicate that dancers present greater ROM
future studies, it would be interesting to include a more dynamic
than non-dancers. Previous evidence has demonstrated that
assessment of the abdominal muscles and to evaluate the dorsal
LBROM is greater in child dancers than in child non-dancers
and low back muscles, not just the abdominal wall muscles. A
(Steinberg et al., 2006) It also appears that LBROM increases with
complete muscle assessment should include strength, endurance,
age, while other joint ROMs stay stable (Steinberg et al., 2006). The

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38 A. Paris-Alemany et al. / Physical Therapy in Sport 33 (2018) 33e39
requirements of dance lead to specific joints reaching greater ROM
than in the general population (Hamilton, Hamilton, Marshall, &
Molnar, 1992). In the low back extension ROM, there were no sig-
nificant differences, which is in line with the findings of Kujala et al.
(Kujala, Oksanen, Taimela, & Salminen, 1997) and could indicate
that physiological low back extension is scarcely improvable due to
the anatomic structure of the vertebral joints.
4.3. Limitations
This study presents several limitations. An important limitation
of this study is that although the control subjects were physically
active, their physical activity level was moderate according to the
IPAQ classification, while the dancers' level was vigorous. For future
studies, it would be interesting to analyze dynamic stability and
lumbopelvic motor control between dancers and non-dancer con-
trols who also perform vigorous physical activity.
As a second limitation, we must consider that the dancers
selected in this study routinely performed Pilates as part of their
physical preparation, which could be a guarantor of lumbopelvic
stability. Finally, we included dancers who professionally practice
various dance disciplines; however, due to the small sample size, it
was not possible to compare the analyzed variables by dance
discipline.
4.4. Perspectives
To our knowledge, this is the first study to analyze the associ-
ations between the lumbopelvic motor control and dynamic sta-
bility of dancers and non-dancers. Our results showed positive
moderate associations between lumbopelvic motor control and
most functional stability measures. These results could stimulate a
new line of research to determine the influence of these variables
on sports performance, prevention and injury rehabilitation.
5. Conclusion
In conclusion, this study demonstrates that dancers perform
lumbopelvic motor control, dynamic stability and most LBROM
better than non-dancers, except for low back extension. Moderate
positive associations were found between lumbopelvic motor
control and dynamic stability in the dancers group. Positive asso-
ciations were also found between IO thickness and some of the
dynamic stability measures in the dancers group, and between the
thickness of the RA with measures of dynamic stability in both
groups.
Conflicts of interest and source of funding
None.
Ethical approval
The La Salle Ethics committee approved this study.
Appendix A. Supplementary data
Supplementary data related to this article can be found at
https://doi.org/10.1016/j.ptsp.2018.06.010.
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