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.
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:
- Back – low back pain – muscle imbalance, back stress fracture, spondylolisthesis, SIJ dysfunction, pars injury, scoliosis.
- Hip – iliopsoas tendinopathy, snapping hip, trochanteric bursitis, labral tear.
- Knee – patella tendinopathy, patellofemoral pain, Osgood-Schlatter disease.
- Leg and Ankle – Achilles tendinopathy, Sever’s disease, posterior ankle impingement, shin splints, FHL tendinopathy.
- Foot – trigger toe, bunions, sesamoiditis, MTPJ inflammation, stress fracture.
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:
- Training Load
- Previous Injury
- 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.
Common Ballet Injuries
- Achilles Tendinopathy
- Achilles Tendon Rupture
- ACL Injury
- Adductor Tendinopathy
- Ankle Fracture (Broken Ankle)
- Anterior Ankle Impingement
- Back Muscle Pain
- Bulging Disc
- Calf Muscle Tear
- Chondromalacia Patella
- Compartment Syndrome
- DOMS – Delayed Onset Muscle Soreness
- Facet Joint Pain
- Fat Pad Syndrome
- Femoroacetabular Impingement (FAI)
- FHL Tendinopathy
- Gluteal Tendinopathy
- Groin Strain
- Hamstring Strain
- High Ankle Sprain
- Hip Labral Tear
- Knee Ligament Injuries
- Meniscus Tear
- Muscle Strain
- Osgood Schlatter’s
- Osteitis Pubis
- Overuse Injuries
- Patella Tendinopathy
- Patellofemoral Pain Syndrome
- Peroneal Tendinopathy
- Pes Planus – Flat Feet
- Plantar Fasciitis
- Poor Hip Core
- Posterior Ankle Impingement
- Posterolateral Corner Injury
- Proximal Hamstring Tendinopathy
- Retrocalcaneal Bursitis
- Sacroiliac Joint Pain
- Severs Disease
- Shin Splints
- Sinding Larsen Johansson Syndrome
- Spondylolysis (Back Stress Fracture)
- Sprained Ankle
- Stress Fracture
- Stress Fracture Feet
- Thigh Strain
- Tibialis Posterior Tendinopathy
Ballet Injury Treatments
Ballet Injury FAQs
Article by John Miller
Elite Sports Injury Management
You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably. Our challenge is to keep up to date with the latest research and put them to work for you.
How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our professional knowledge.
What Should You Do When You Suffer a Sports Injury?
Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases. The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days. After that, you need to get it moving, or other problems will develop.
Ice or Heat?
We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.
Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.
Should You Use a Compressive Bandage?
Yes. A compressive bandage will help to control swelling and bleeding in the first few days. In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support, such as a brace or strapping tape. Please ask us if you are uncertain about what to do next.
Gravity will encourage swelling to settle at the lowest point. Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries. Think where your damage is and where your heart is. Try to rest your injury above your heart.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek professional advice as certain medications can interfere with other health conditions, especially asthmatics.
When Should You Commence Physio?
In most cases, "the early bird gets the worm". Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits. These include:
- Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
- Improving your scar tissue using techniques to guide the direction it forms
- Getting you back to sport or work quicker through faster healing rates
- Loosening or strengthening of your injured region with individually prescribed exercises
- Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.
What If You Do Nothing?
Research tells us that injuries left untreated take longer to heal and have lingering pain. They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome.
What About Arthritis?
Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:
- An inappropriately treated previous injury (e.g. old joint or ligament sprains)
- Poor joint positioning (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition)
- Loose joints (excessive sloppiness causes joint damage through poor control)
What About Your Return to Sport?
Your physiotherapist will guide you safely back to the level of sport at which you wish to participate. If you need guidance, ask us.
What If You Need Surgery or X-rays?
Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury. Please use our advice to guide you out of pain quicker. And for a lot longer.
If you have any questions regarding your sports injury (or any other condition), don't hesitate to get in touch with your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.
Acute Sports Injury Clinic
How to Best Care for Your Sports Injury?
There is never an excellent time for an injury. But we do know that most sports injuries occur over the weekend! That's why at PhysioWorks, we have established an Acute Sports Injury Clinic at a selection of our clinics on a Monday and Tuesday.
The acute sports injury consultation fee is significantly lower than a routine assessment and treatment consultation. In most cases, your private health will cover the full cost of your full acute injury physio assessment fee.
Why Use an Acute Sports Injury Clinic?
Your Acute Sports Injury Assessment Consultation allows us to provide you with:
- A quick and accurate diagnosis. One of our Sports Physiotherapist's or an experienced sports injury-focused Physiotherapist will confidently guide your new injury management.
- Early acute sports injury care, professional advice and education. What to do this week?
- Fast referral for X-rays, ultrasound or MRI scans to confirm your diagnosis.
- Prompt referral to Sports Physicians, GPs or Surgeons with whom we work if required.
- Immediate supply of walking boots, braces and rental crutches if needed.
- Low-cost professional service.
For more friendly advice or guidance, please call your nearest clinic to discuss your specific needs.
Article by Zoe Russell
Who is a Sports Physiotherapist?
Sports Physiotherapy is the specialised branch of physiotherapy which deals with injuries and issues related to spokespeople. Practitioners with additional formal training within Australia are Sports & Exercise Physiotherapists.
What is Sports Physiotherapy?
Sports injuries do differ from common everyday injuries. Athletes usually require high-level performance and demand placed upon their body, which stresses their muscles, joints and bones to the limit. Sports physiotherapists help athletes recover from sporting injuries and provide education and resources to prevent problems.
Each sports physiotherapist usually has sport-specific knowledge that addresses acute, chronic and overuse injuries. Their services are generally available to sportsmen and women of all ages engaged in sports at any level of competition.
Members of Sports Physiotherapy Australia (SPA) have experience and knowledge of the latest evidence-based practice, professional assessment and diagnosis of sports injuries, and effective hands-on management techniques and exercise protocols to assist recovery and prevent future damage. SPA members have access to the most recent advances in sports physiotherapy. You'll be pleased to know that most PhysioWorks physiotherapists and massage therapists have a particular interest in sports injury management.
When Can You Return to Sport?
Ultimately, your sports physiotherapist, doctor or surgeon determine your safe return to sport. They will take into consideration your tissue healing and how well your function has progressed in your rehabilitation. Returning to sport too early can delay healing and prolong recovery and pain.
Your physiotherapist will aim to speed up the process via some hands-on treatment techniques, graduated exercises, plus, most importantly, strength, functional, sport-specific and agility exercises to replicate your sport. Sometimes protective bracing or taping may allow an early return to sport.
As a general rule, most soft tissue injuries and bone injuries will take a minimum of six weeks for scar tissue maturation or a bone healing phase. Therefore, caution is required. Please discuss with your sports physiotherapist, surgeon, or sports physician who can liaise with your coach.