Updated: Jan 17
A narrative review of pole dance physiology and injury research
Since the modernisation of pole dancing in the late 90’s/early 00’s, there has been a growing thirst for knowledge and information surrounding this art form. For many years there was a slow but steady drip of opinion pieces and research published on the sociological, psychological and cultural aspects of pole dancing (i.e feminism, sexuality and stigmas associated), but a significant lack of research published on the physiological demands of the sports and injuries that may occur.
Well, it’s time for the pole dancing nerds of the world to rejoice! Over the past 4-5 years there has been a scattering of articles published on this topic and my top-secret sources tell me there’s even more on its way!
So what we thought best to do is to round up what’s currently out there in the literature and talk through them all, with an aim to provide 6-12 monthly research updates along the way!
Disclaimer: Pole dance research is still very much so in its infancy. As such, each study has multiple limitations. To ensure we’re getting the full picture we’ve included them in our discussion below!
Let’s first break down the research that talks about the physiological demands of pole dance. Not going to lie, we’re about to get super nerdy, so stay with us here!
1. Pole dancing for fitness: The physiological & metabolic demand of a 60-minute class.
Lead author: Dr Joanna Nicholas (2018).
Before we dive into this article, we just want to take a moment to chat about the lead author of this article. The OG of pole researchers, Dr Joanna Nicholas, is not only the first ever researcher to complete her thesis in pole dancing psychology, physiology and injuries, but has legitimately led the way for so many more researchers to complete their studies. So for that, we salute you @drjoannanicholas! If you’re a science and pole nerd like us, make sure you’re following her on socials to stay up to date on all her upcoming pole research!
In this article, Dr Nicholas and her team were finally able to provide quantitative evidence to all those claims made over years about how beneficial pole dancing is. This was the first study to our knowledge that has measured physiological and metabolic demands of a 60-minute standardised pole class.
By assessing a range of physiological values (mean heart rate, rating of perceived exertion, energy cost, oxygen consumption, and blood lactate) of 14 advanced level biological female polers over 3 x 60-minute pole classes, Dr Nicholas and her team were able to classify pole dancing as a form of moderate-intensity cardiorespiratory endurance exercise per the American College of Sports Medicine Guidelines (required intensity of between 2.0-5.9 METs).
This might not seem like a big thing for some because we already know just how hard pole dancing is. But this was the first ever study that quantified exactly how hard pole is to the rest of the world! And it supports the argument that pole dance is a legitimate exercise form and when performed 5 days a week for greater than 30 minutes at a time we are likely meeting our required adult exercise needs to improve health and cardiorespiratory fitness.
Furthermore, this study confirmed classes with a greater dance/routine-based focus expend more energy than stand-alone trick classes. So for individuals seeking elevated intensity of training and energy expenditure, routine-based training is recommended.
Every study has limitations because it’s hard for research to mimic the exact demands of real-world situations. The main limitations to this study are:
Small sample size of 14 participants
The classes were run for an advanced level - results may differ considerably between different teachers, studios and levels.
Skills training and routine/dance training were completed consecutively in all classes. Classes which focus solely on tricks or dance may elicit a different overall result.
There may have been a learning effect over the three classes which could in theory reduce difficulty and intensity of the class for the participant.
This study focused on the short-term metabolic responses to the demand of a standardised 60-minute pole dance class. Randomised longitudinal research is required to confirm long-term health benefits
2. Biomechanics and physiology in top level pole dancers: A case study
Lead Author: Bruno Ruscello (2018)
This article is a smaller case study that aimed to look at the biomechanical and physiological demands of pole dancing in elite level dancers. We view case studies as the lower end of high-quality evidence in the medical/research world as they usually focus on a very select group of people and the results lack generalisability to the pole population. However, they are always a great starting point for research and can help us pinpoint areas in which future research needs to be undertaken.
This particular case study was the assessment of 3 elite level pole dancers (2 female, 1 male aged between 24-35) during a 3-minute and 30-second pole dance routine. They were required to remain on the pole for 3 of those minutes and assessment was undertaken via measurement of blood pressure, heart rate, blood lactate concentrations and postural stability.
In particular, this case study found the rate of acceleration and the magnitude of gravitational force placed on the body at all times highlighted the constant workload demand placed on the body. The highest amount of work occurred when the pole dancers ‘broke the body’ along the pole during controlled phases of falling or dropping down (i.e exiting into a drop). The pole dancers in this study experienced a breaking phase requiring almost 3 graviton during their drops.
They also noted the adaptation of the vestibular (balance) system on a spinning pole to allow efficient control and movement to allow for dance expression whilst involved in rotating movements on the pole of a magnitude of ~ 400o/s. All three dancers strongly relied on their sight as a balance strategy throughout their routine.
The final outcome of this study: pole is hard. Between the rotating forces, gravitational forces, friction forces and the demands placed on the cardiovascular, vestibular and musculoskeletal systems, our bodies have our work cut out for them. Pole dance is a highly skilled form of fitness that poses heavy requirements on the individual and on the authors’ words, it is a ‘discipline that needs a careful and skilled training methodology (and) specific coaching knowledge’ to allow the athlete to handle its demands.
Ok break time! How we handling all this info so far?
If you’re not used to reading research it can definitely feel overwhelming, but hopefully you’re finding our summary is making it that little bit easier to understand. Trust me when I say we’ve sorted through the technical mumbo jumbo for you!
So now we’ve covered the physiology (yes, just 2 studies), we are going to deep dive into the injury surveillance studies that have been published. Now you’ll find that there’s a bit of discrepancy with the results of the studies. But remember, our research is still in its infancy and none of the designs of these studies are perfect so it’s hard to replicate exactly what’s happening in the pole world! But as a collective, they do give us a fairly good idea and snapshot.
Alrighty, let’s do it!
1. Musculoskeletal injuries in pole dancers: A prospective
Lead author: Dr Joanna Nicholas (awaiting publication in 2022)
Another study by superstar Dr Joanna Nicholas and her team, this study is a part of her thesis looking at injuries in the pole dance world.
This study collected injury data prospectively from 66 Australian pole dancers over a 12-month period. They looked at demographics and characteristics of pole dancers, activity exposure, injury incidence, and the most commonly injured anatomical sites, types and mechanisms of injury. Data from injuries that occurred during pole-specific and pole-related activities were recorded (i.e flexibility training etc).
So what did they find?
Over the 12 months 103 injuries occurred, with a total injury incidence rate of 8.52 per 1,000 activity hours. For those who don’t know, that’s a high number. For a quick comparison, gymnastics has an injury rate of only 5.2/1000 hours.
Out of these injuries, 59.2% were acute with 40.8% being overuse. The shoulder (20.4%) and hamstring (11.7%) were the most common site of injuries. The primary contributing factors of injury were loaded internal humeral rotation of the shoulder (twisted grip) and front splits for the hamstring.
Joanna and her team flagged the need for injury screening programs and targeted injury risk reduction (injury ‘prevention’) strategies in pole studios to address the areas of the body at highest risk of injury.
Additionally, we at The Pole Physio would like to add our personal opinion (since we’re already talking about it). We firmly believe that studios should look to address how these more challenging pole positions are taught to students with good instructor training (i.e. technique cues), but more importantly they should look at when they are taught in their syllabus (i.e true grip should be taught before twisted grip and handsprings should not be taught at the same time as an Ayesha!).
Limitations to this study are that the patient was diagnosed by their choice of physiotherapist which introduces bias of non-consistent diagnostic reporting (limited by the Physiotherapists’ knowledge and skillset) and in many cases participants self-diagnosed their injury (medical care was at the participant’s expense). In addition, there was a high drop-out rate of participants and a small sample size of injuries included, limiting our ability to extrapolate results to a large pole population.
This study flags the need for future research to understand the mechanical demands of pole tricks, with the aim to implement an injury prevention framework internationally to reduce the risk of injury.
2. Types of the locomotor system injuries and frequency of occurrence in women pole dancers –
Authors: Agnieszka Goluchowska & Marta Humka (2021)
This study via a retrospective survey examined the types and frequency of musculoskeletal injuries amongst 213 amateur (140) and professional (73) pole dancers.
58% of dancers involved reported an injury (slightly higher in professionals – 68 vs 52%). Across both groups, the shoulder joint was the most commonly injured site (44% in amateurs vs 50% in professionals). Other key areas of injury for amateurs were the forearm (22%), hamstrings (19%), ankle (19%) and wrist (18%). Whilst the professionals experienced injuries mainly in the hamstrings (34%), the wrist (22%), the spine (22%) and the ankle (18%).
These results echo that of Dr Nicholas’ PhD which showed shoulders and hamstrings were at highest risk of injury. The key areas to note between the groups were the considerable increase in spinal injuries in the professional group compared to the amateurs (22% vs 7%). On a personal note, this is something that we also see reflected in the patient numbers that we treat.
Also, recurrent injuries were more likely in the professional dancer (47% vs 27%). The areas at highest risk of re-injury in both groups were the shoulder and hamstrings. The wrist and spine also had a higher risk of re-injury in the professional population.
The biggest limitation of this study is that it is a self-reported survey. Patients often misreport due to a variety of factors, and evidence shows that questionnaires asking for memory recollection greater than 1 year increase the risk of bias incorrect self-reporting significantly. In the case of this study, athletes were required to report on injuries they sustained throughout their entire pole career.
Furthermore, patients often report the site of the pain, not the diagnosis – i.e bicep pain instead of a specific shoulder or neck injury causing their pain. This lack of accuracy in reporting can skew the results significantly of the data presented.
3. A small series of pole sport injuries
Lead author: Florian Dittrich (2020)
This particular article is a published series of case studies on the risks of acute injury from falls from a pole and was performed retrospectively on 4 biological female patients who sustained acute injuries between 2011-2017. Patients were contacted years post injuries and case files/radiology was retrieved to determine the severity of the injuries. All of the injuries sustained were traumatic.
The injuries sustained by these polers were:
Patient 1: clavicle fracture (surgically fixed)
Patient 2: L2-4 transverse process fractures and pelvis contusion
Patient 3: 2 separate incidences of concussion
Patient 4: ankle sprain
In all of these incidences a safety mat was not used. It’s unclear in the study as to whether the polers were amateur or professional polers, however this case study makes a strong argument that crash mats are important and are used in other sports such as gymnastics and circus. Regardless of level, we would encourage all polers to utilise a crash mat with training, particularly when first learning a new move. Over time when confidence has been established in a trick it may be appropriate to remove the safety mat.
4. Musculoskeletal Injury Prevalence and Profile in Pole Dancers
Lead author: Sue Havens (not published)
This study aimed to identify the prevalence of musculoskeletal injury, and associated risk factors, in 231 pole dancers through a retrospective survey. This study has not been published yet to our knowledge and as such is not peer-reviewed. Furthermore, despite attempts at reaching out to the authors, we were unable to gain full access to the article, so are unable to assess methodology and limitations of research.
This study determined an injury rate of 8.95 per 1000 hours of exposures, with the most commonly injured region being the shoulder (28.7%), followed by the wrist (14.7%), and hips/thighs (12.2%). 63% of injured participants had more than one musculoskeletal injury in the past year, with the upper extremity being the most likely involved.
Shoulder injury appeared to be more prevalent in the higher skilled polers and those who had been poling for greater than 2 years. And there was a slight association with those who had a higher training frequency to competition involvement.
The results of this study appear in line with the results of Dr Nicholas’ PhD and Goluchowska & Humka (2021).
5. Prevalence of Pole Dance Injuries From a Global Online Survey
Lead Author: J. Y. Lee (2020)
Similar to the previous study, the authors distributed a web-based survey to 158 polers of different skill levels, retrospectively assessing for pole injury characteristics across a spectrum of pole dance levels.
In this study the most commonly reported injuries were shoulder (54.5%), wrist (34.2%) and back (24.7%). 75.5% of injuries were acutely sustained.
77% of the subjects recovered in less than 3 months from their injuries. For recovery, about two-thirds of the subjects added rest to their training schedule to recover from their injury, 44% added stretching exercises, 35% added strengthening exercise, 33% added more pole dancing and 26% added yoga or Pilates...
But of great concern was that only 22% of those injured went to see a physiotherapist or other movement professional for rehabilitation! From experience treating this population, there tends to be a negative culture towards assessment as most polers report concern they will have to stop the activity completely and others report financial concern (despite continuing with paying the costs and associated secondary experiences of class!)
One of the most interesting findings from this study was that they found pole dancers over the age of 40 were 3.7 times more likely to need longer than 3 months to recover from injuries compared to those aged from 19 to 29 years. This was the first study that looked into age as a risk factor.
They also found participants with 3 to 6 years of pole sport experience were at 3.9 times higher risk for moderate/severe injuries compared to those with less than 3 years’ experience. After 7 years of poling there was no increased risk.
Wondering why this might be the case? Usually we find this is the time in a poler’s career that they are learning the heavily loaded tricks such as Ayeshas, handsprings and deadlifts. Our theory is that once the body has learnt to handle the demands of these tricks, their risk of injury naturally reduces. But whilst they are building up the capacity the risk will naturally be much higher.
6. Epidemiology of injuries in pole sports
Lead author: Vasileios Mitrousias (2017)
Whilst published, the full study has been unobtainable to date. Comments are in relation to information from the abstract. This article was a retrospective case series based on hospital records of 34 patients who presented to the hospital emergency department between December 2015 and July 2016.
It’s important to note that the injures documented in this study are only the ones that present to emergency department which may not be reflective of the usual range of injuries that occur in the pole community.
From the injuries documented, 29.4% were low back and hip pain, 17.7% were wrist injuries and 14.7% were ankle sprains. Concussion was present in 5.9% of presentations.
Interestingly, no shoulder injuries presented to hospital during this period despite all previous studies listing the shoulder as the most commonly injured area of the body. We theorise that most injuries in this study were likely traumatic injuries secondary to falls or similar. This was the first study that documented concussion rate in pole dancers. It is paramount that further research is undertaken to document the injury characteristics of concussion in pole dancers.
7. The risk of injuries and physiological benefits of pole dancing –
Lead author: Mariusz Naczk (2020)
This small size, controlled study looked to gather and compare information on injuries and physiology between 30 pole dancers and 30 non-pole dancers. They were tested for strength, flexibility and body composition and surveyed on lifestyle, diet, injuries sustained during everyday life and during pole dance, weight, menstruation and warm up.
It will come as no surprise that the pole dancing group had greater strength and flexibility compared to non-pole dancers, and less body fat and greater muscle mass compared to the control group. Interesting to note, pole dancers were more likely to have irregular periods and were less likely to seek appropriate care after an injury (this links in with the results of Lee’s study in 2020).
Of the participants, 40% had an acute injury and 80% reported an ongoing chronic injury. Most of the injuries sustained in this study were in the wrist and shoulders (similar to previous results). And interestingly, this was the first study that documented an association between injury risk and those participants who did not warm up. This is everything we know in other sport literature to date, but it’s great to see it documented in pole research too! Additionally, an increased injury risk was also found with those who were on a restricted calorie diet, again confirming what we already know in other sports and now nicely demonstrating how important nutrition is in the pole population. Good food for thought! (See what we did there….! )
8. Factors associated with injury and re-injury occurrence in female pole dancers –
Lead Author: Andrzej Szopa (2022)
Ok last one! Literally. This is the most recently published study. It’s a freshie from January 2022 and true to form for these studies, this was another retrospective survey this time aimed to determine what participant, training and post-injury related factors are associated with injury and re-injury in 317 biological Polish female pole dancers of all different skill levels.
As the largest study done to date, this study builds nicely on research previously published. 85% of the 317 pole dancers included in this study reported sustaining an injury. 84% of the injured cohort did not attend physiotherapy. Yes, 84%. We are definitely going to be talking about this later in the piece.
48% of those injured then went on to re-injure the initial injury. Might have something to do with not seeking medical care perhaps?
Of those who sustained a re-injury, 83% of them did not fully recover. This is a huge number. And what’s even more interesting is that 88% of those who re-injured attended physiotherapy. This is showing us that pole dancers tend to neglect an injury the first time it happens but when they re-injure it, they finally tend to it. The second part of this statistic that is concerning us is the high number of injuries that didn’t resolve with physiotherapy.
Let’s side track for a second and talk about this. It’s important.
The study does not unfortunately detail what the physiotherapy is that these participants received. But there is a concerning trend in the medical world to provide massage and mobilisation to injuries alone. Whilst these techniques may assist with pain relief it’s important to understand that they will often not be enough to address the injuries of a pole dancer. Injuries require a biopsychosocial approach when it comes to management. And most of the time this will involve progressive strengthening to assist the poler in their return to meet the demands of their sport, review of their training schedule, review of their pole technique, review of their diet and medical health and review of any psychosocial factors and maligned beliefs that the poler may have in regards to their injury.
One of the most common issues we see with non-resolved pole injuries is that the health care professional treating is not aware of the demands of the pole world and are unsure how to fully rehabilitate the injury site back to the level required to handle the load of the trick. This allows the injury cycle to viciously continue. We pride ourselves at The Pole Physio for taking a hands off approach with manual therapy and a hands on approach with addressing all of the key factors involved in injury management. And as a result, we have a high injury resolution rate amongst our patients. Not only do they get back to pole injury free, but because we have strengthened them way beyond previous levels, they zoom through moves that were once their nemesis tricks! This is where we would love to see health care head towards over the next few years, particularly in the pole community.
Ok. Enough on that. Back to the study.
Over 30% of the injured cohort reported injury influenced their level of activity and over 50% reported constant pain discomfort. Majority of the injuries sustained related to the lower extremity (59%) and upper extremity (39%).
Risk factors that increased risk of initial injury were increased height of the pole dancer, higher training experience and pole dance specific training load, body mass index (BMI), history of previous non pole dance related injuries and the role/experience of the pole dancer. A short pause in training and incomplete recovery significantly increased the odds of re-injury. And the lower the level experience in pole training (beginner or basic level), the higher the risk of re-injury.
Key limitations to note with this article is that it was a retrospective study of injuries over their pole career. As noted previously, this significantly increases risk of self-reporting accuracies.
The key take home from this article for us are that the pole dancers were not actively seeking appropriate medical care for their injuries the first time they got injured despite the high risk of injury in this sport.
Congrats! You made it through the heavy stuff. So you now might be wondering…
What does this all mean??
Research in the pole dance community has grown over the past few years from literally nothing to now multiple studies. And there’s many more still yet to come.
Whilst these studies may not provide consensus on areas commonly injured and injury rates, they do tell us one clear thing; injury rates are very prevalent in pole dance and there is a negative culture towards injury prevention and management in the pole community. It tends to be very much a ‘she’ll be right’ attitude.
Furthermore, there is an unwritten understanding in the pole community that we are tough, so we just push through pain. But this is clearly coming at the determinant of ourselves in the short and long term. Pole dance related injuries need to be taken more seriously in our community and not ignored as what is common practice. Only when they receive adequate care will our risk of re-injury reduce in the community.
Additionally, more time effort and resources need to be placed into injury risk management and injury risk reduction in the first place. As a sport we tend to be reactive instead of proactive and it’s time for a change. Injury risk reduction (injury prevention) strategies are in place in every other sport out there except pole dance. But they have been proven time and time again to be incredibly effective at reducing risks across a range of sports! So, ask yourself why we aren’t adopting these strategies?
Unfortunately, the answer is the lack of education. Our instructors do a fabulous job at instructing, but there still is a global lack of understanding in the ways in which we can work to reduce injury risk in our students. Unlike other sports we do not have ready access to strength and conditioning coaches, physiotherapists and exercise scientists.
This is why we at The Pole Physio Australia medically advocate for pole dancers. And we appreciate when you listen up and take the time to read and share these blogs. Because we want change for our industry. The industry needs change and that change starts with you.
How can you help? Firstly, by understanding that pole is a highly demanding sport. There are certain moves that pole dancers perform that place a very high demand on our body that are more likely to increase our risk of injury.
To reduce our student’s risk of injury we should look to actively screen them to determine whether they are ready for the demands of a trick before teaching it.
Prioritise you/your student’s safety at all times.
Encourage crash mats.
Don’t push yourself/ your students too hard too quick. Be respectful of their body and its capacity.
Ensure your injuries and your students’ injuries are being seen to by a health care professional.
Review your syllabus and determine whether it is progressive and appropriate to the levels. And don’t be afraid to include screening in your syllabus. We will discuss screening in the next section below.
Make sure you’re investing in your instructors by ensuring they are receiving professional development and training from the best. Good cueing, spotting and technique can significantly reduce the risk of injury of your students and instructors. Less injuries = a better experience for all involved. Studios; we offer online workshops for instructors. Contact us via email if you’re interested.
Understand that more pole training often overworks our body and leads to injury. We need to find the ‘just right’ amount for our body.
Pole takes time. Don’t rush the process, short cuts do not work. Instead work hard, screen frequently and enjoy your journey.
Also please understand that our risk of injury is heavily controlled and fluctuates with factors including nutrition/hydration, sleep, psychosocial status, stress/mood, sudden changes/spikes in our load and poor technique.
Keeping up to date with medical based sources like The Pole Physio to ensure you’re doing everything you can to stay injury free.
There are a lot of resources out there from so called ‘specialists’ in the pole world without proper certification or medical training. We implore you to not get sucked into shiny or gimmicky social media pages offering you the perfect fix. Instead, we encourage you to look towards highly experienced pole instructors and health care professionals who preach evidence-based medicine to assist you on your way.
And remember, no instructor or personal trainer should ever provide you with medical/injury advice. This is entirely out of their scope of practice.
Screen and prepare
The most important point we commonly raise on our pages and socials is that we can reduce the risk of injury by screening our students and preparing them appropriately for the next move they are above to learn.
Every pole dance trick out there can be assessed and broken down into its demands or functional movement patterns. I.e does the exercise require pulling or pushing strength? Or both? Does the arm need to be overhead or in a position of internal rotation? These questions matter! Once we can determine the needs of a trick, we can screen polers to ensure they are adequately meeting the demands of the trick before attempting it. And this my friends is how we reduce our risk of injury!
Now I know I make this sound all easy, but in reality how are y’all supposed to know what the demands of the move are if you’re not trained to know this. Well quite simply, YOU’RE NOT! This is where we come in! We provide so many free anatomy resources to educate you on everything that goes into a trick. We provide loads of free off and on the pole conditioning to help, and we promise that over time it will all begin to make sense!
There’s no point attempting an Ayesha if you can’t get your pushing arm to at least 180o of shoulder flexion. This is a basic requirement of this move. But I cannot tell how many patients I see weekly who have injured their shoulder attempting this move and they don’t have usually greater than 160 degrees on either side.
If we are going to LOAD our bodies, then we must ensure our body has the baseline CAPACITY for the movement and ideally even more.
And this is where the research is heading.
We currently don’t have a gold standard in injury risk screening in pole dancers because no research has been done on it. But this is why it’s more important than ever before to listen to health care professionals who understand the sport and can guide you.
Did you know that with every anatomy series breakdown we have done, we suggest a screening guide at the end to make sure you’re ready for the trick?! Yes we do! Go back and look through them all to check it out.
What if you’re not ready for the trick? No worries. You can work on your strengthening on and off the pole to build up your capacity so you will soon enough be ready for it! And yes – this will reduce your risk of injury!
It’s so important in the meantime that you and your instructors don’t place your body in harm’s way. Our instructors and health care professionals should be encouraging smart training practices which focus on screening for tricks, gradual progression through pole studio syllabus (and yes – the syllabus should be progressive!), and there should be a huge emphasis on safety (i.e cue the crash mats, good spotting and cueing!).
There needs a be culture shift towards safety and injury prevention in pole.
And we are pushing for this hard!
This sort of change begins with our instructors and leaders within our pole community. And it needs to be filtered through our studios all over the world. We’ve already seen a huge shift in the way studios are practising over the past 2 years.
But there’s room for more. Make sure you are doing everything you can to keep yourself and your student’s injury free.
Are you wanting to reduce your risk of injury under professional healthcare guidance with a tailored pole specific program? All whilst smashing through your nemesis tricks. Touch base with our Pole Physio online.
Online telehealth appointments can be booked with the Pole Physio via our ‘Book Online’ page that can be found here. Assessment and tailored rehabilitation are provided in accordance with best practice and evidence-based treatment to help you unleash your 'poletential'.
Until next time, train safe.
The Pole Physio
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Havens, S., Donnelly, A., & Mathiyakom, W. (unpublished). Musculoskeletal injury prevalence and profile in pole dancers. California State University, Northridge
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Mitrousias, V., Halatsis, G., Bampis, I., Koutalos, A., Psareas, G., & Sakkas, A. (2017). Epidemiology of injuries in pole sports: Emerging challenges in a new trend. British Journal of Sports Medicine, 51(4), 362-363.
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Nicholas, J. (2019). The psychological, physiological and injury-related characteristics of pole dancing as a recreational activity. Doctor of Philosophy, The University of Western Australia, https://doi.org/10.26182/5e7d60d09e2cd
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