Overview of Ballet Injuries
by Ya-Ti Lin
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Table of Contents
- Introduction
- Warning
- Align yourself
- The Pointe Shoe Doctors Recommend
- Ask an Expert
The validity of the ballet injury research, like other sport injuries, is very poor due to the often non-fatal nature of the injuries caused by all variety of reasons including improper training techniques, long-term wear-and-tear of musculoskeletal structures, biological and environmental factors. Underreporting leads to a lower than actual number of injured cases can decrease the public awareness and increase bias in many related studies. In Taiwan, and perhaps in most countires, the epidemiologic research on this topic is so scarce and we can barely find published papers with a target population towards ballet dancers.
Classical ballet has its profound history dated back to 14th century. Introduction to the pointe work as a part of the aesthetic of ballet movements and techniques was a great invention but pointe shoes also give dancers with nightmares due to injuries that are caused by erroneous use of them. This has a significant impact on professional ballet dancers and it can result in shortening their career on stage, or even worse, they can end up disabled.
The purpose of building this web page is to increase the awareness of ballet injuries in the field of epidemiology which is often mistakenly thought to be more directly related to research on ancient or emerging infectious diseases or chronic diseases such as cancer, cardiovascular diseases, or coronary heart diseases. Epidemiology can be extended to be a very broad field of science to target all variety of morbidity and mortality in any population, including ballet dancers.
I have constructed a Ballet Injury Report Form to gather some preliminary data to understand the prevalence of ballet injury among ballet dancers in Taiwan.
For you as a ballet dancer or if you know anyone who is learning ballet, please take some time to fill out the Ballet Injury Report Form in order to give ballet techniques a new scientific approach of justification.
Dancing is good for you - it's great for the body, the mind and the spirit. However, dancing and especially dancing en pointe has an inherent risk of injury. Use common sense. No shoe can ever make dancing easy, painless or risk-free. Do not attempt to dance on your toes or to use pointe shoes until a qualified ballet teacher determines that you have sufficient strength and technique. Wear pointe shoes only in a proper dance studio under a teacher's supervision. Never use a dancing shoe that is not in good condition.
A 115 lb. dancer who sickles only 2&186;,as shown above, may transfer 40 lbs. to the lateral ankle, the site most vulnerable to sprain. While dancing, these forces may
increase to 10 times her body weight.
Dancers are better aligned in Gaynor Minden pointe shoes according to an independent study recently completed by the Exercise Science Department at the University of Massachusetts, Amherst led by Lise Worthen, B.F.A., a graduate student and Research Assistant in Biomechanics. Proper alignment is extremely important not only for ballet technique, but also for correct muscular development and for protecting the joints from injury.
In the study, ankle adduction ("sickling" in dance terminology), was reduced and, on average, subjects stood straighter in Gaynor Mindens. These results were announced at the 15th Annual Performing Artists Medicine Association Conference in Aspen, CO on June 21, 1997.
In an earlier separate study*, 80% of professional dancers were shown to suffer an injury to one or both ankles at some time in their careers. Worthen now points out that the high rate of injury may be a reflection of forces at work in the dancer's ankle joint - forces which reach up to 10 times a dancer's body weight in full plantar flexion (en pointe), according to an earlier study by Canadian biomechanists.** Worthen, a former ballet teacher at Bates College, says, "Straight ankle alignment is stressed as a part of proper ballet technique. This is a biomechanically smart element of technique because misalignment transmits these high forces to the medial/lateral ankle structures."
Worthen's study used a kinematic analysis of dancers' ankles. The test subjects were advanced level ballet students with at least eight years training. Two video cameras and Motion Analysis software were used to record and analyze the dancers.
"Preventing sickling and winging is important," says Worthen in the text of the study, "because each degree of misalignment in a dancer means force directed to the medial/lateral ankle structures (ligaments, bones, tendons and associated muscles). For example, the dancer who straightened her alignment by 12° in the experimental shoe (Gaynor Minden), alleviated approximately 24 lbs of laterally placed force each time she balanced en pointe... Seen in this light, redesigned pointe shoes may be important ergonomic tools for ballet dancers."
* McNeal, Watkins, Clarkson and Tremblay (Medical Problems of Performing Artists), 1990.
**Galea and Norman (International Series on Biomechanics, V.5A), 1984.
In conventionally-made pointe shoes, there is possible risk of injury if the shank should suddenly break or soften.
Gaynor Mindens have unbreakable shanks. In an independent study, using a flex-test machine that simulates relevés, Gaynor Mindens' shanks and boxes lasted more than 200,000 cycles - 3 to 28 times longer than the other major brands tested.
You can't put an orthotic into a pointe shoe, but Gaynor Mindens' pre-arched shanks provide strong, consistent support, right where doctors recommend it. If needed, they are easily adjusted with an ordinary blow drier.
A dancer wearing conventionally-made pointe shoes may have an increased risk of stress-fracture and other injury due to a lack of shock-absorption.
Although no pointe shoe can make dancing easy, painless or risk-free, Gaynor Minden uses high-tech cushioning materials that provide superior comfort and minimize the traumatic impact of landing from jumps. Gaynor Minden uses Rogers Corporation's Poron® 4000, which carries the American Podiatric Medical Association Seal of Acceptance.
Conventionally made pointe shoes may break in unevenly so that platform ceases to be level. This creates the likelihood that the dancer will be out of alignment en pointe, which can stress the joints, particularly the ankle.
Gaynor Mindens' elastomeric boxes cannot be softened or broken in. The sides of the platform never round down to permit "sickling" and "winging" (potentially injurious forms of misalignment). Gaynor Mindens make the dancer roll up to pointe, and balance en pointe, with the proper alignment that is required for correct technique and that is also less likely to stress the ankle.
Katy Keller, P.T. addresses three issues of interest to all dancers in Turnout, Tendinitis and Bunions
Alycea Baylis-Ungaro, P.T. answers your questions in Ask A Physical Therapist
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