Ballet and Dance (Care of the Young Athlete)

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Dance is an artistic, athletic, expressive, and
social form of physical activity that appeals to a wide variety of individuals.
The physical aspects of dance can be both a valuable source of exercise as well
as a cause of injury. For young people who take dance classes, have formal
training in dance, or perform as dancers, they typically do so in one of the
following dance disciplines: ballet, jazz, modern, tap, hip hop, Irish, or

There are many forms of dance that have unique
physical demands and specific injury risks. There are also some physical demands
that are common to a wide variety of dance forms. For example, many types of
dance involve jumping, turning, toe pointing, back arching, and lifting. These
activities can produce tendinosis, stress fractures, ankle sprains, ankle
impingement, or low back pain.

The following is information from the American
Academy of Pediatrics about common ballet and dance injuries and their symptoms.
Also included are 3 common questions from dancers.

Common injuries

Injury Description/Cause Symptoms
Flexor hallucis longus tendonitis Inflammation of tendon that flexes big toe; tendon is stressed
with releve, jumps, pointe work.
Pain, tightness, and/or weakness along the tendon in arch or
behind the inner part of the ankle.
Symptomatic os trigonum Extra piece of bone behind ankle joint (found normally in
20% of individuals) gets pinched when the toes are
pointed and ankle is flexed downward.
Pain, tightness, and occasional swelling behind ankle associated
with releve, pointe work, and going up on toes.
Anterior talar impingement Pinching of soft tissues in front of ankle with ankle bending
Pain, tightness, pinching sensation in front of ankle with
pli?, preparing to jump, and landing from jump.
Ankle sprain The ankle inverts (collapses inward) most commonly when dancers
are on their toes while jumping, landing, or turning.
Pain, swelling on outer ankle; sense of instability with
sideways movement; sprains are more common if there has been a
previous sprain.
Stress fracture Repetitive impact stress can cause weakening of bone; often
without a visible crack seen on x-ray. Common in metatarsals
(forefoot), tarsals (midfoot), tibia, and fibula (leg) and
occasionally femur, pelvis, and spine.
Persistent, deep, bony pain associated with high levels of
impact activity; more common in dancers with calcium or vitamin
D deficiency, eating disorders, and menstrual
Patellofemoral pain syndrome Pain under the kneecap from pressure associated with knee
bending, pli?s, jumps; can lead to softening or thinning
of cartilage behind the kneecap.
Dull, achy anterior knee pain that increases with knee bending,
pli?s, and jumps.
Snapping hip Multiple causes including tendon snapping over front or side of
hip; associated with active hip movement; occasionally due to
torn cartilage lining the hip socket but very unlikely due to
dislocating hip.
Snapping sensation that may or may not be painful; occasionally,
dancer has a sense that the hip is going out of place;
occasionally, there is a catch or pinching sensation deep in
joint when hip is bending.
Pars injury The pars interarticularis is a part of the spine that is
stressed with back extension (arching); pain or weakening of the
pars most commonly occurs during periods of rapid bony growth.
Injuries to this area may be referred to as spondylolysis, or
stress fracture of the spine.
Tightness, achiness in central part of the low back that is
worse with arching, jumping, running, and lying prone; better
with forward bending; nerve symptoms and radiating pain are rare
with this condition.
Disc injury Weakening or bulging of lumbar disc; due to repetitive trunk
bending, twisting, or lifting. Athletes may also get a vertebral
end plate (growth plate) injury.
Low back pain that extends to the flank or buttock; may spread
to thigh; occasional numbness or tingling; worse with sitting,
bending, lifting, and lying down with face up; better with
arching and lying down with face down.

Frequently asked questions

Q: When can I begin pointe work?

refers to performing dance steps on the tips of the
toes. This technique is used only by female dancers. Trying pointe work
too soon can lead to risk of sprains, fractures, and growth plate
injuries. Most experts believe that a dancer is ready to try pointe work
when the following criteria are met:

  • Age range 9 to 15 years; 12
    is average (assuming other criteria below are met)

  • Three or more years of
    classical ballet training; 2 or more classes per week of
    preprofessional training (Instructors who have trained
    professional dancers can usually determine when a dancer has
    the necessary experience, technical skill, and strength to
    go en pointe.)

  • Sufficient bony

  • Adequate strength in arch,
    ankle, leg, hips, trunk muscles

  • Adequate balance and

  • Adequate supervision and
    training, including carefully graded skill progressions and

Q: Can I improve my turnout?

refers to the ability to externally rotate the hip. Not all dancers can
achieve optimal turnout because they may be limited by their bony
anatomy. For example, the depth and angle of a dancer’s hip
socket may affect how far he or she can rotate his or her hip. However,
most dancers can improve their turnout with appropriate exercises. For
example, turnout can be improved by stretching the hip joint and the
muscles on the inner side of the hip joint.

Optimal turnout allows dancers to stand
with their feet pointing opposite directions while their knees are
positioned directly over the feet. If turnout is not done correctly,
dancers are either unable to hold this position or they
“cheat” by twisting their knees or forcing their lower
legs to the outside. When the hip, knee, and foot are not in alignment,
leg and low-back injuries can occur.

Q: How can I safely lose weight?

A: Dancers of all ages face
tremendous pressure to be thin. The pressure may be based on aesthetic
or performance requirements. At times, targeted weight goals may be
unhealthy. Not getting enough calories and nutrients can contribute to
less energy, impaired brain functioning (like poor concentration), and
increased risk of illness and injury. When unsafe weight loss practices
are used to reach a desired appearance, health risks can include serious
illness, hospitalization, and even death.

Dancers who want to lose weight should
use a medically supervised strategy. This includes working with a
medical professional to determine how much weight loss is safe, how
quickly the weight can be lost, and how nutritional and energy
requirements will be met. It may also be helpful to work with a
registered dietitian. It is essential to have regular medical monitoring
to evaluate the safety and efficacy of the weight loss program.

For answers to additional questions about injuries, injury prevention,
and safe training practices, talk with your doctor or a physical


Ballet and dance injuries can be prevented with
proper supervision and compliance with the rules and safety guidelines in place
for ballet and dance.