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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 11  |  Issue : 2  |  Page : 45-48

Prevalence of ankle instabilities and disabilities among female Kathak dancers


Department of Physiotherapy, Punjabi University, Patiala, Punjab, India

Date of Submission21-Jul-2017
Date of Acceptance16-Oct-2017
Date of Web Publication19-Jan-2018

Correspondence Address:
Dr. Roopika Sabharwal
House No. 1055, Sector 21, Panchkula, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/PJIAP.PJIAP_18_17

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  Abstract 

BACKGROUND: Kathak dancers are required to perform certain complex mudras at their foot involving extreme ranges. This may make them prone to ankle instabilities. The purpose of this study was to find out the prevalence of ankle instabilities and disabilities among the Kathak dancers.
METHODS: Screening of forty female Kathak Dancers was done for the study from the Department of Dance, Punjabi University, Patiala, on the basis of inclusion criteria. Subjects were assessed for Ankle Instabilities and Disabilities through Foot and Ankle Disability Index (FADI) and Cumberland Ankle Instability Tool (CAIT).
RESULTS: Percentile analysis of the scores obtained from both FADI and CAIT was done. 70% of the Kathak Dancers were found to suffer from Foot and Ankle disability. 90% of the Kathak dancers were found to have ankle instability at left side while 75% were having ankle instability at the right side.
CONCLUSION: Kathak dancers are prone to develop functional disability and instabilities at ankle joint. This may be attributed to the complex postures accomplished by them at foot. It is important to advise them about the prevention and treatment of their foot problems. Ergonomic education to these dancers also holds importance.

Keywords: Complex postures, cumberland ankle instability tool, Foot and Ankle Disability Index, foot problems, functional disability, Kathak dance


How to cite this article:
Sabharwal R, Singh S. Prevalence of ankle instabilities and disabilities among female Kathak dancers. Physiother - J Indian Assoc Physiother 2017;11:45-8

How to cite this URL:
Sabharwal R, Singh S. Prevalence of ankle instabilities and disabilities among female Kathak dancers. Physiother - J Indian Assoc Physiother [serial online] 2017 [cited 2018 Apr 20];11:45-8. Available from: http://www.pjiap.org/text.asp?2017/11/2/45/223700


  Introduction Top


Kathak dance is portrayed by hasty swirls, refined footwork, and acuate postures. Lot of variations are seen in different dance forms of Kathak as it has a history of being passed on from one person to another in a guru shishya parampara. Apart from this, slight variations are introduced when the learners adapt the postures according to their own body inclinations. However, some primitive movements remain unchanged in general.[1] The basic movements accomplished at the foot in Kathak dance are Udghattita, Sama, Agratalasanchara, Anchita, and Kunchita [Figure 1].
Figure 1: Various Foot Postures adapted by Kathak dancers during their performance. Source: Khare[2]

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In Udghattita, forefoot comes in contact with the ground hence bearing weight, and afterward heel is brought down. Sama is the initiating position of the Kathak dance performance. Feet are placed on the ground naturally (neutral position). This position is also used to tap the foot repetitively on the floor. In Agratalasanchara, heel is raised up with toes placed on the ground, and all the fingers are held in the bent position. In Anchita, the heel is in contact with the ground with the raised forefoot and all the fingers held in the bent position. In Kunchita, heel is raised up along with fingers and midfoot in the bent position. A movement called Soochi is also performed sometimes in which whole foot is raised up, and only big toe is in contact with the ground.[2]

Thus, the foot is repetitively taken to extreme the ranges of dorsiflexion and plantarflexion while performing Kathak, thus making excessive use of these muscles. Dorsiflexion places the ankle into its most stable position as the trochlea of the talus, and the articular surfaces of the tibia and fibula are in the “close-packed” position [Figure 2].[3] Extreme dorsiflexion of the leg over the talus causes the mortise to explode outward, rupturing many of the collateral ligaments. It elongates the posterior capsule of the ankle joint and other soft-tissue structures such as Achilles tendon. Plantarflexion is a loose-packed position. Full plantar flexion slackens most collateral ligaments of the ankle and all plantar flexor muscles. It also causes the distal tibia and fibula to loosen its grip from the talus. Bearing all body weight over a fully plantarflexed ankle, therefore, places the talocrural joint at a relatively unstable position. Landing from a jump in a plantarflexed and usually inverted, position increases the likelihood of injuring the mortise.[4]
Figure 2: Arthrokinematics of ankle joint during passive (a) Dorsiflexion and (b) Plantarflexion. Neumann[4]

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Ligaments of the ankle joint are put under tension during the dance performance. The syndesmotic ligaments are also under maximum tensile loading in these positions. In addition, these positions also cause the talus to press against the lateral malleolus which places considerable stress on the ankle mortise, thus putting the foot into high risk of instability.[5]

Other positions which are responsible for increasing the risk of ankle instability are forced external rotation and forceful eversion at foot. Both these positions widen the ankle mortise and drive the talus into external rotation.[6] During bhramaris (chakkars), the dancers perform whirling movements at the body. They rotate by considering heel as the fulcrum with the ankle held into dorsiflexion [Figure 3]. Thus, there occurs combination of the dorsiflexion and external rotation thereby increasing the risk of ankle instability. Repetitions of these postures throughout the performance slacken the ligaments cause strength deficits in muscles thus making the ankle highly unstable and prone to injury.
Figure 3: Dorsiflexion taking place at the feet of the Kathak dancers while taking turns (Bhramaris). Source: Bureau T. Preserving the Kathak tradition. The Hindu. Available from: http://www.thehindu.com. [Last accessed on 2012 Jul 28]

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In our previous study on Kathak dancers, emphasis was laid on the development of foot postural deviations in Kathak dancers.[7] Foot Postural deviations may lead to the development of stability problems in these dancers. In this study, detailed assessment has been conducted for the ankle instabilities in Kathak dancers.


  Methods Top


An observatory study was performed for analyzing the Kathak dancers for instability and disability at foot. Screening of 40 female Kathak Dancers was done for the study from Department of Dance, Punjabi University, Patiala, on the basis of inclusion criteria. The inclusion criteria allowed considering female Kathak dancers falling within the age group of 18–35 years with a minimum dancing experience of at least 2 years. It was ensured that the dancers practice Kathak for a minimum of 4 or <4 h/week.

Subjects with any history of recent surgery at lower limbs, any neurological deficit at foot or any congenital deformity which may affect the functionality of the lower limbs were excluded. In addition, dancers who were professionally inculcated in any outdoor sports activity such as football, athletics, badminton, soccer, judo, etc., were excluded from the study to restrain the results of the study from any error.

Procedure

For appraising the extent of disability, Foot and Ankle Disability Index (FADI) was used and for instability, Cumberland Ankle Instability Tool (CAIT) was used.

The FADI helps to assess the functional limitations related to foot and ankle conditions. It is focused on the subject's performance during the activities of daily living. The FADI consists of 26 questions with 104 total points. Each is scored as a percentage of the total points possible. For each question, subjects have to select the most appropriate response that best describes their condition. Responses to choose from include no difficulty at all (4 points), slight difficulty (3 points), moderate difficulty (2 points), extreme difficulty (1 point), and unable to do (0 points). A score of ≤90% on the FADI indicates that a subject has FAI.[8]

The CAIT consists of nine questions with a total score of 30 points. Lower scores indicate more severe functional ankle instability (FAI). It is the only questionnaire which takes into account both left and right feet individually at a time. A score of ≤27 indicates a subject has FAI, whereas a score of 28 or higher indicates no FAI. The CAIT has an excellent reliability with an intraclass correlation coefficient of 0.96.[9]


  Results Top


The data were analyzed using Microsoft Office Excel 2010. Mean and standard deviations were analyzed for demographic Details. Percentile analysis was done to analyze the results.


  Discussion Top


In the present study, 70% of Kathak dancers were found to have functional ankle instability FAI as per the scores obtained through FADI [Figure 4]. Scores obtained from CAIT suggested that 90% of the Kathak dancers were found to have FAI at the left foot and 75% were having it at the right foot [Figure 5].
Figure 4: Percentage of Kathak dancers with foot and ankle disability

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Figure 5: Percentage of Kathak dancers having functional ankle instability at left foot (a) and right foot (b)

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These results can be attributed to certain foot postures adapted during Kathak dance such as Udghatitta, Agratalasanchara, etc., which consists extremes of dorsiflexion and plantarflexion. They may lead to putting of the ligaments of the ankle joint under tension. According to Norkus et al., when the ankle is either in the fully dorsiflexed or plantarflexed position the syndesmotic ligaments are under maximum tensile loading.[5] In addition, these positions may also cause the talus to press against the lateral malleolus which places considerable stress on the ankle mortise thus putting the foot into high risk of instability.

Other positions which are responsible for increasing the risk of ankle instability are forced external rotation and forceful eversion at foot. During bharamaris (turnouts), the foot is rotated while maintain the plantarflexed position. They lead to widening of the ankle mortise and thus, drive the talus into external rotation.[6] Repetitions of these postures throughout the performance may slacken the ligaments causing strength deficits in muscles.

A combination of the mechanical insufficiencies such as arthrokinematic changes (widening of ankle mortise, etc.) with the functional insufficiencies such as muscular imbalance leads to recurrence of ankle sprain and instability.[10] According to a study, ankle sprains were found to be frequent in Ballet dancers. They result from working in the positions which allow increased risk of sprain on the lateral side of the ankle for many hours a day.[11]

Other factors responsible for the FAI includes changes in coordination due to transitions in ankle synergy, proprioceptive deficits, etc., which can occur during fast and rapid dance steps, swirls, foot tapping, etc.[12] However, this is the limitation of the study that the present study did not analyze these factors. Many other factors which lead to instability such as proprioceptive and coordination deficits were not considered in the study. In the future, Kathak dancers can be evaluated for various other factors such as mechanical instabilities, proprioceptive, and other neuromuscular deficits. A treatment approach can be formulated and tested specifically for the Kathak dancers according to their profession and lifestyle.


  Conclusion Top


With time, Kathak dancers become prone to develop functional disability and instabilities at ankle joint. It is important to advise them about the prevention and treatment of their foot problems. Ergonomic education to these dancers also holds utmost importance. Development of treatment plan which can be at par to their profession-specific demands is also essential.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Morelli S. Intergenerational adaptation in North Indian Kathak dance. Anthropol Notebooks 2010;16:77-91.  Back to cited text no. 1
    
2.
Khare S. Chari Bheda (Division of Leg Movements). Kathaka, Saundaryatmaka Shastriya Nritya: Gahan Adhyayana Evam Chintana, Kanishka Publishers; 2005: p. 106-18.  Back to cited text no. 2
    
3.
Donatelli AR. The Biomechanics of the Foot and Ankle. 2nd ed. Philadelphia: F.A. Davis Company; 1996.  Back to cited text no. 3
    
4.
Neumann DA. Lower extremity. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. St Louis: Mosby; 2010. p. 584.  Back to cited text no. 4
    
5.
Norkus SA, Floyd RT. The anatomy and mechanisms of syndesmotic ankle sprains. J Athl Train 2001;36:68-73.  Back to cited text no. 5
[PUBMED]    
6.
Lin CF, Gross ML, Weinhold P. Ankle syndesmosis injuries: Anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Ther 2006;36:372-84.  Back to cited text no. 6
[PUBMED]    
7.
Sabharwal R, Singh S. Foot postural deviations in female Kathak dancers. Int J Physiother 2017;4:38-43.  Back to cited text no. 7
    
8.
McKeon OP, Hertel J. Spatiotemporal postural control deficits are present in those with chronic ankle instability. BMC Musculoskeletal Disord 2008;9:76.  Back to cited text no. 8
    
9.
Hiller CE, Refshauge KM, Bundy AC, Herbert RD, Kilbreath SL. The Cumberland ankle instability tool: A report of validity and reliability testing. Arch Phys Med Rehabil 2006;87:1235-41.  Back to cited text no. 9
[PUBMED]    
10.
Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train 2002;37:364-75.  Back to cited text no. 10
[PUBMED]    
11.
Hamilton WG. Sprained ankles in ballet dancers. Foot Ankle Int 1982;3:99-102.  Back to cited text no. 11
[PUBMED]    
12.
Tropp H. Commentary: Functional ankle instability revisited. J Athl Train 2002;37:512-5.  Back to cited text no. 12
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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