‘Headspin Hole’ and the Hazards of Breakdancing

While breakdancing recently captured the world’s attention during the Summer Olympics in Paris — thanks, in part, to the Australian breakdancer Raygun — few spectators were likely aware of the sport’s unique injury risk known as the “headspin hole,” which was highlighted in a recent case report.

The report detailed the case of a male breakdancer in his 30s who developed a large scalp protuberance (33.4 × 0.6 × 2.9 cm) that was caused by more than 5 years of “extensive headspinning practice,” wrote Mikkel Bundgaard Skotting, PhD, and Christian Baastrup Søndergaard, MD, both of Copenhagen University Hospital in Denmark, in BMJ Case Reports.

They described the “headspin hole” as an overuse injury that presents as a fibrous mass on the scalp, which can be accompanied by hair loss and tenderness.

“The occurrence of the bulge itself was not surprising, given the high energy and repetitive strain placed on that particular area of the head during breakdancing,” Søndergaard told MedPage Today. “However, the unusually large size of the mass did stand out.”

The patient reported that his training regimen included five sessions a week, each lasting around 1.5 hours. Notably, the mass had not prevented the patient from continuing to practice the headspin maneuver, the authors noted.

An MRI revealed “significant subgaleal fibrosis and thickening of the subcutis, consistent with the ‘cone-head sign,'” but a histological analysis showed no malignancy, Skotting and Søndergaard said. Due to the size of the mass on the patient’s scalp, they decided to surgically remove it.

The surgery was successful and a postoperative follow-up showed a significant reduction of the mass.

In a patient perspective included in the case report, the patient wrote that he was very satisfied with the surgery and that “it is now possible for me to go out in public without a cap/hat which is, of course, a very nice feeling.”

The authors explained that the goal of this case report was to share their insights and experience in hopes that it might help other physicians and patients in the future. There is very little literature on this condition — also referred to as a “breakdance bulge” — despite a relatively high prevalence among people who practice breakdancing.

A German study of 106 breakdancers in Sportverletz Sportschaden, one of the few papers on the condition, showed that 60.4% experienced overuse injuries to the scalp due to headspins. Among those cases, 31.1% experienced hair loss, 36.8% experienced scalp inflammation, and 23.6% reported the development of painless head bumps.

“Breakdancing is undoubtedly a physically demanding sport, which makes it prone to various types of injuries,” Søndergaard said. “With the inclusion of breakdancing in the Olympics, we may see an increase in the number of athletes experiencing breakdancing-related bulges, particularly due to frequent headspinning.”

“Fortunately, as seen in this case, the injury can be effectively treated, though athletes will need to avoid headspinning post-surgery to prevent recurrence,” he added.

Ryan Wilkinson, EdD, LAT, ATC, a board member for the National Athletic Trainers’ Association, told MedPage Today that it is not uncommon for the general public to show a sudden interest in unique sports following events like the Olympics.

“The challenge we often find is when individuals get into new activities or sports like this, the body is placed into challenging repetitions, positions, or angles and there are all kinds of tension and leverage placed on parts of their body,” Wilkinson said.

Those who try these sports should consider how to prepare for these new movements and exercises in order to minimize injury, he noted, adding that the most important thing people can do before beginning a new activity like breakdancing is understand the risks.

“It’s just a different stress that’s placed on the body and their muscles, their tendons, their ligaments; the skeletal structure might not be as able to accommodate the stress or the repetition,” Wilkinson said.

Another important factor is age, he added. If someone hasn’t played sports or danced in years, they may not realize that their body has changed in ways that might increase their risk of injury.

For healthcare professionals, Wilkinson said that a case like this illustrates the importance of keeping up with the literature, especially in sports medicine, since popular events or trends can lead to some unique medical needs for patients.

Søndergaard agreed that this report “highlights the importance of recognizing injuries associated with niche athletic activities like breakdancing.” He noted that it will be important to understand how to prevent such injuries as the sport gains more mainstream interest.