October 6, 2017

Treating ballet dancers

Rob Footitt

Given the demands of speed and agility, ballet dancing should be considered an athletic activity. Dancers certainly require the same levels of strength, endurance, psychological readiness and aerobic capacity as high-level athletes.

As with any athletic activity, injuries are common in dancers. Whilst there are similarities between dancers and other athletes, there are also differences in training and attitude which require a slightly different approach to treating and rehabilitating a ballet dancer.

In comparison to most sports, ballet dancers tend to spend more time during the day practising and rehearsing. This time commitment can make it difficult to decide to stop dancing due to injury. Professionals also have to consider the importance of maintaining their position within their company.

Maintaining body image and technical ability can lead to stress and loss of confidence, and this in turn can lead to poor lifestyle choices such as eating habits, and the demands of training and rehearsals can reduce rest time. These factors can introduce fatigue and burnout which then increases stress.

It is also widely recognised that dancers often exhibit a higher pain threshold and tolerance of pain to non-dancers. This can lead to a poor ability to distinguish between pain due to exercise and the pain of injury.

Common contributing factors to dance injury:

Improper training

Repetitive jumping

Poor alignment of body weight

Disregarded overuse/fatigue

Faulty technique – sickling, winging, in demi pointe or en pointe

Rolling in – over pronation

Environmental – hard floors, ill-fitting shoes

Structural deformity – hallux rigidus, hallux valgus, pes planus (flat feet), pes cavus (high arch)

Biomechanical imbalance – poor core strength, weak eccentric leg strength, pelvic muscle imbalance or inflexibility, tight Achilles tendon, hypermobility.

Management of injury:

Many of the above are treatable and can be managed with the correct support; however it is vital that professionals who treat dancers have an understanding of the demands of ballet dancing.

For instance, because of the intense training and dedication that dancers have to their careers, simply telling them not to dance can be unhelpful and discourage them from continuing treatment.

Instead, a physical training regime outside of their normal dance training will improve muscular strength where required and increase cardio respiratory endurance as well as aerobic and anaerobic capacity. In addition, this type of training can improve emotional wellbeing.

Dancers should be encouraged to keep to a healthy nutrition plan and ensure that they have enough rest to eliminate the effects of fatigue. This down time can also improve their physical and emotional health.

Although environmental factors such as dancing on hard floors are outside of the remit of health professionals, they can work with dancers to identify particular physical and psychological attributes, previous injuries and planned training and performance schedules. This can identify areas for improvement and reduce the risk of future injuries.


Jeffrey A Russell. Preventing dance injuries: current perspectives. J Sports Med. 2013; 4: 199–210.

Leavesley, R., and A. M. Borthwick. “Foot and lower-limb injury in ballet: dancers’ perspectives.” British Journal of Podiatry 6.3 (2003): 13-19.

Howse, A. J. G. “The young ballet dancer.” Ryan AJ, Stephens RE. Dance Medicine: A Comprehensive Guide. Chicago: Pluribus Press, Inc (1987): 107-114.

Russell, J. A. “Breaking pointe: foot and ankle injuries in dance.” Low Extrem Rev 4.1 (2012): 18-22.


Knees, Recovery and Performance, Sports therapy, Training
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