Ballet Injuries

Ballet Injuries

Article by Nadine Stewart

Ballet Injuries

What are the Common Injuries in Ballet?

Ballet is a specific form of dance that requires strength, control, balance, agility, flexibility and cardiovascular fitness. This amazing sport and art form also involves extensive practice and discipline to master the techniques required for performance.

Overuse Injuries

Most dancers train between 6 to 35 hours per week. Due to the number of training hours and repetition involved in ballet, many of the injuries sustained by dancers are overuse injuries rather than acute injuries. This means that the injury is the result of gradual wear and tear that progressively worsens over time, rather than being caused by one specific incident. It is very important to have these types of injuries treated early, and the cause of the injury corrected so that the injury doesn’t worsen to a point where it is restricting everyday activities, including dancing.

Often overuse injuries can be caused by a number of factors including growth spurts, muscle imbalance, incorrect technique, a change or increase in usual training load, a change or increase in usual rehearsal and performance schedule or incorrectly fitting footwear esp. pointe shoes.

The most common overuse injuries in dancers fall into three categories including; tendinopathies, sprains (injuries that involve ligaments) and strains (injuries that involve muscles). Some common overuse injuries for ballet dancers include:

Dance injuries and prevention strategies are best developed with the assistance of a dance physiotherapist.

More Information:

Acute Injuries

Even though acute or traumatic injuries are not as common in ballet in comparison to overuse injuries, they still occur in the dancing population. Acute injuries are characterised by the injury appearing suddenly, usually as the result of a specific incident, e.g. loss of balance.

Acute injuries occur in the dancing population for a number of reasons including loss of control during the large number of quick multi-directional movements required in dancing, lifts associated with partner work (pas du deux), in addition to positions that require the dancer to move both their joints and muscles into extreme ends of range, where these structures are at a mechanical disadvantage.

The most common acute injuries in dancers fall into two categories including; sprains and strains. Some common acute injuries in ballet dancers include:

  • Back – facet joint irritation, muscle imbalance and spasm.
  • Hip – hamstring strain, adductor strain, labral tear.
  • Knee – patella dislocation, meniscus tear, quadriceps strain.
  • Leg and Ankle – gastroc strain, ankle sprain.
  • Foot – trigger toe, turf toe.

What Causes Injuries in Ballet?

Due to the large amount of lower limb work in ballet, it is no surprise that the lower limb is the most commonly injured area. There is some debate in the research as to which lower limb area is the most commonly injured, however, the ankle, hip, knee, foot, leg, and thigh are the areas most commonly injured among dancers, especially female dancers.

Low back injuries are the second most commonly reported injuries in ballet. This often occurs due to large amounts of lifting in pas du deux work, or lower limb elongation required for the performance of an arabesque, jeté, battement, and développé. Low back injury often results from overusing the low back to compensate for the under utilisation of the hips and buttocks.

Injuries to the head, neck, trunk and upper limbs are the least likely injuries to occur in the dancing population. However, when they do occur, they are more likely to occur in the male dancers due to the lifting elements required.

Risk Factors for Injuries in Ballet

There are a number of risk factors that lead to injury among dancers including:

  • Age
  • Gender
  • Training Load
  • Previous Injury
  • Hypermobility
  • Flexibility
  • Strength
  • Technique
  • Footwear / equipment

How Can Injuries in Ballet be Prevented?

The best treatment for an injury is prevention. To prevent injury from occurring, the best option is to work on strength, flexibility, control, and balance. For guidance specific to your personal requirements, please speak to your physiotherapist for advice. Your physiotherapist will generally talk to you about your goals, training and injury history, and will complete a number of physical tests to determine an appropriate injury prevention program.

It is very important to warm up and cool down prior to participation in classes, rehearsals, and performance. This ensures that the muscles are warm and joints are moving smoothly and evenly before moving these structures into positions where they may be at a mechanical disadvantage, and at risk of injury.

The technique is very important in ballet, and repetitively performing movements with the incorrect technique can lead to injury. Your dance physiotherapist will be able to work with you to improve your technique to reduce your risk of injury.

In dancing it is of great importance to look after your feet. As a result, you need to ensure that your ballet shoes (ballet flats, demi-pointe or pointe shoes) are of the correct fit, especially during periods of growth. When you are not wearing your ballet shoes it is important to spend some additional time assisting your feet to recover through the use of massage and toe exercises. Some individuals also find it helpful to place cotton balls between the toes, to counteract the compression of the toes in ballet shoes. Please speak to you physiotherapist regarding preventative exercises for the feet to match your individual needs.

As exciting as it can be to progress onto pointe, it can also lead to injury if the individual dancer is not ready for the physical demands that dancing en pointe requires. It is important to speak to your physiotherapist regarding the physical requirements that you will need to develop before you are safe to progress onto pointe to assist with injury prevention.

Dance Screening & Assessment

Return to Ballet Post-Injury

Despite your best efforts to prevent it, injury can occur in any sport and ballet is no exception. If you do become injured, your physiotherapist will work with you to assist your recovery and safe return to ballet. Proper recovery from injury is very important to enable a safe return to dance, to prevent reaggravation or worsening of the injury, and to prevent any subsequent injury from occurring as a result of the body compensating for the original injury.

Recovery may involve a number of elements, including passive treatment, which can include taping, massage, manual therapy techniques and ultrasound, which will be carried out by your physiotherapist, tailored to your recovery needs.

However, despite these treatment modalities, the responsibility for your recovery also lies with you, with the active component of treatment. This includes exercises to assist with stretching tight muscles, strengthening weak muscles and correcting movement patterns.

Lastly, allowing your body to recover is also very important in the rehabilitation of an injury. This may involve taking a short break from training, or in many cases, limiting certain areas of your training that aggravate your injury to enable it to heal. This may allow you to continue to train as you recover. Your physiotherapist will work with both you and your coach/instructor to assist with the management of your training load.

At PhysioWorks, a number of our physiotherapists have an interest and skills in dance physiotherapy, and would be happy to discuss your treatment options with you.

More info:

Dance Injuries

Dance Screening

Pre Pointe Assessment

Tertiary Dance Assessment

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.