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Tielle Lyons

INJURY PREVENTION IN BALLET DANCERS: WHAT’S THE POINTE?

Classical ballet is typically practiced in two different kinds of shoe; ballet flats (left) or pointe shoes (right). A dancer must train in ballet flats prior to dancing ‘en pointe’, otherwise known as on pointe.

Pointe shoes facilitate the dancer’s ability to hold their entire bodyweight through the tips of their toes in a series of aesthetically pleasing movement sequences. Typically, a dancer’s goal is to make these movements look effortless. But don’t be fooled – negotiating this footwear is no effortless feat!

Studies have shown that when weightbearing on pointe shoes, a dancer can place up to an astounding twelve times their bodyweight through their foot (9).

You read that correctly – twelve!

Injury Profile: Classical Ballet Dancers

These intense physical demands significantly increase the risk of injury in this population. Research shows that pre-professional ballet dancers (training at the same technical demands and intensity as professional dancers) experience 1.42 injuries per dancer each year – meaning they experience more than 1 injury per year (10),(4),(3).

Unsurprisingly, injuries to the lower extremity account for approximately 77% of these injuries, with 27% more specifically affecting the foot and ankle (10),(11),(12).

How can physiotherapy help?

Staying injury-free is a top priority for dancers, and research shows that physiotherapy can be a game-changer. It has been show by research (13) to help reduce pain, boost movement ability, and improve lower-body flexibility in dancers dealing with both short- and long-term injuries.

Even better, ballet-specific physiotherapy exercises can slash injury rates by up to 82% in just one year (14).

For dancers, that’s a major leap toward a healthier, longer career. But how can this be done?

Here are three of our top tips for reducing your risk of injury as a ballet dancer:

1. REGULAR REPLACEMENT OF POINTE SHOES

Studies have shown that the condition of a dancer’s pointe shoes is the most significant contributing factor to injury amongst classical ballet dancers, followed closely by high training volumes and overuse (5).

When pointe shoes become worn out, dancers often refer to them as ‘dead,’ meaning they no longer provide the necessary support for the foot and ankle. ‘Dead shoes’ can lead to greater forefoot and ankle plantarflexion (‘pointing’) when weightbearing in pointe shoes, meaning that surrounding muscles and ligaments must work significantly harder to maintain ankle stability.

Ensuring pointe shoes are well-fitted and replaced frequently is essential to help reduce injury risk and support the intense physical demands of ballet (10),(4),(3).

2. ENGAGE IN REGULAR STRENGTH TRAINING

Dancers should be encouraged to partake in regular strength-based training outside of their ballet classes. This can significantly aid in injury prevention, and should primarily focus on stabilising muscles of the lower limb and core. For example, weakness in the stabilising muscles of the hip has been shown to increase the likelihood of ankle sprains due to its link with ankle posture when weightbearing on pointe (7).

Regular strength training not only reduces the risk of injury, but it can significantly enhance performance both on and off pointe. Research shows that a sixteen-week lower limb strength training program can make drastic improvements to vertical jump height in dancers, which is a particularly desirable skill in this sport (2).

This doesn’t just have to involve gym-based weight training. Techniques like Clinical Pilates and floor barre aren’t just trendy—they’re proven to fine-tune movement patterns, prevent injuries, and enhance performance across many dance styles (1)(8).

3. REVIEW COMMON CORRECTIONS IN CLASS: PREVENT UNHELPFUL MOVEMENT PATTERNS FROM FORMING

Many dancers are used to hearing the same corrections in class—“turnout!” or “don’t sickle!”—over and over. While these instructions are meant to perfect technique and enhance aesthetics, they also highlight potential injury risks linked to poor movement patterns.

Take the ‘turnout’ position, for example, which is crucial in many ballet lower-body positions. It requires the legs to rotate outward, positioning the feet accordingly. While it may seem like this rotation comes from the feet, most of the ‘turnout’ in weight-bearing positions should actually come from the hip joint (6) (9).

But what if a dancer’s hips can’t physically achieve that range? That’s where ‘cheat movements’ come in—dancers may adjust their position to create the appearance of turnout without maintaining correct technique. Two common cheat movements are:

1. Turning the feet inward or flattening the arch (‘pronation’).

2. Slightly bending the knees, adjusting the feet, and re-straightening the knees to achieve outward rotation from the knee joint.

Although these tricks might mimic proper turnout, they place unnecessary strain on the body and can increase injury risk over time. Pay attention to corrections, and if unsure, consult your physiotherapist (6).

Dealing with dance injuries or niggles?

Book a session with our dance physiotherapist, Tielle!


Tielle has a keen interest in helping performers reach their full potential. With 20 years of experience in a range of dance styles and a decade training as a circus performer specializing in both floor and aerial acrobatics, Tielle blends her passion for performance with her knowledge of physiotherapy. She understands the unique physical demands of dancers, acrobats and other artistic athletes – whether on pointe or in the air!

Whether you’re recovering from an injury, working to prevent one, or pushing yourself to new heights, give us a call on 9455 1177 or book online today via the button below.

Happy dancing!

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References

  1. Ahearn, E. L., Greene, A., & Lasner, A. (2018). Some Effects of Supplemental Pilates Training on the Posture, Strength, and Flexibility of Dancers 17 to 22 Years of Age. Journal of Dance Medicine & Science, 22(4), 192–202. https://doi.org/10.12678/1089-313x.22.4.192
  2. Ávila-Carvalho, L., Conceição, F., Escobar-Álvarez, J. A., Gondra, B., Leite, I., & Rama, L. (2022). The Effect of 16 Weeks of Lower-Limb Strength Training in Jumping Performance of Ballet Dancers. Frontiers in Physiology, 12. https://doi.org/10.3389/fphys.2021.774327
  3. Smith, P. J., Gerrie, B. J., Varner, K. E., McCulloch, P. C., Lintner, D. M., & Harris, J. D. (2015). Incidence and Prevalence of Musculoskeletal Injury in Ballet. Orthopaedic Journal of Sports Medicine, 3(7), 232596711559262. https://doi.org/10.1177/2325967115592621
  4. Ekegren, C. L., Quested, R., & Brodrick, A. (2014). Injuries in pre-professional ballet dancers: Incidence, characteristics and consequences. Journal of Science and Medicine in Sport, 17(3), 271–275. https://doi.org/10.1016/j.jsams.2013.07.013
  5. Li, F., Adrien, N., & He, Y. (2022). Biomechanical Risks Associated with Foot and Ankle Injuries in Ballet Dancers: A Systematic Review. International Journal of Environmental Research and Public Health, 19(8), 4916. https://doi.org/10.3390/ijerph19084916
  6. Morris, M. L., Nunez, P., Scott, A., & Carey, S. L. (2020). Analyzing the Use of the Fifth Position in Dance Training. Springer EBooks, 143–163. https://doi.org/10.1007/978-3-030-37480-8_10
  7. Richardson, M., Liederbach, M., & Sandow, E. (2010). Functional Criteria for Assessing Pointe-Readiness. Journal of Dance Medicine and Science , 14(3), 82–88. https://doi.org/10.1177/1089313×1001400302
  8. Sabo, M. (2013). Physical Therapy Rehabilitation Strategies for Dancers: A Qualitative Study. Journal of Dance Medicine & Science, 17(1), 11–17. https://doi.org/10.12678/1089-313x.17.1.11
  9. Shah, S. (2021). Readiness for Dancing En Pointe. Physical Medicine and Rehabilitation Clinics of North America, 32(1), 87–102. https://doi.org/10.1016/j.pmr.2020.09.004
  10. VILAR, P. L., KOVAČIČ, T., & GERŽEVIČ, M. (2024). View of Injury prevention and physiotherapy procedures for ankle injuries in ballet dancers. Retrieved August 20, 2024, from Zrs-kp.si website: http://ojs.zrs-kp.si/index.php/AK/article/view/349/428
  11. Hess, G. W. (2011). Ankle Impingement Syndromes. Foot & Ankle Specialist, 4(5), 290–297. https://doi.org/10.1177/1938640011412944
  12. Rietveld, A. B. M. B., Hagemans, F. M. T., Haitjema, S., Vissers, T., & Nelissen, R. G. H. H. (2018). Results of Treatment of Posterior Ankle Impingement Syndrome and Flexor Hallucis Longus Tendinopathy in Dancers: A Systematic Review. Journal of Dance Medicine & Science, 22(1), 19–32. https://doi.org/10.12678/1089-313x.22.1.19
  13. Skwiot, M., Śliwiński, Z., Żurawski, A., & Śliwiński, G. (2021). Effectiveness of physiotherapy interventions for injury in ballet dancers: A systematic review. PLoS ONE, 16(6), 1–18. https://doi.org/10.1371/journal.pone.0253437
  14. Vera, A. M., Barrera, B. D., Peterson, L. E., Yetter, T. R., Dong, D., Delgado, D. A., … Harris, J. D. (2020). An Injury Prevention Program for Professional Ballet: A Randomized Controlled Investigation. Orthopaedic Journal of Sports Medicine, 8(7), 232596712093764. https://doi.org/10.1177/2325967120937643