You Ready For This?
One of the most exciting times for a young aspiring ballerina is the day when they go to get fitted for their first pointe shoe. I still remember mine vividly. But....
What determines readiness for pointe?
According to a 2022 Systematic Review (where the authors gather all the information from every research article they can find on one particular subject), many factors have been used to determine pointe readiness. These include:
· Core, ankle & pelvic stability.
· Core, lower limb and ankle strength,
· Range of motion (ROM) or flexibility of the foot and ankle (90 – 100 degrees of plantar flexion),
· Lower limb alignment,
· Years of training (at least 2 years of ballet),
· Musculoskeletal maturation
· Stability and control when going up and down from pointe,
· Undertaking at least 2 other ballet classes per week.
...phew! That's a lot to consider.....
There is, however, no Universal screening protocol…!
This means that it is up the individual teacher to ensure that they are recommending their dancers be assessed by the appropriate health professional before commencing pointe classes.
When looking at age, it is important to note that chronological age does not necessarily correlate with musculoskeletal / bone age. Growth plates become vulnerable to remodeling during puberty which may cause malformations and muscle growth may not keep up with bone growth resulting in changes in motor patterns, changing the way the dancer moves and / or balances. This may also result in higher rates of injury.
“The ankle is exposed to 12 – 13 times your body weight of force”
Due to the increased loads, if the gastrocnemius, soleus and flexor hallucis longus muscles are not strong enough to keep the ankle and foot stabilised, the risk of injury is increased.
Some of the injuries that may occur include:
· Posterior ankle impingement and ankle sprains
· Stress fractures (due to decreased ROM)
· Inflammation of the bursa where the Achilles tendon attaches and
· Inflammation at the small bones on the ball of the foot near the big toe (due to poor technique while wearing ill-fitting pointe shoes).
Picture from https://james-mccormack.com/advice-centre/posterior-ankle-impingement/
According to the 2022 review, some of the tests that have been used to date to determine pointe readiness include:
· Saute test,
· Airplane test,
· Topple test,
· Releve endurance,
· Isometric and isokinetic strength and
· Star excursion balance test – 3 directions.
Airplane test- Picture from IADMS Bulletin for Dancers and Teachers, Volume 6, Number 1, 2015 pg. 7
The review concludes by stating that there is a lack of research and statistical evidence confirming any conclusive testing protocols, indicating that more research is needed in this area.
Dancewright therefore recommends that dancers approaching the age and / or ballet level where they may be recommended to begin pointe engage in a pre-pointe readiness program. This would entail strength and conditioning for the areas mentioned above that will reduce the risk of injury and confirm pointe readiness upon a screening by a health professional such as a dance physiotherapist.
Some dance schools incorporate a pointe readiness class into their timetable which is a fantastic addition for young dancers, however not all schools are equipped, have the time or knowledge to provide this service. If your school does not have this type of program, it is highly recommended that dancers do not start pointe without a comprehensive review by an dance specific health professional such as a physiotherapist.
As an Exercise Physiologist, I am able to assess strength and weaknesses in your dancers’ body and prescribe a progressive exercise program for optimal preparation for pointe work. Sessions may be individual, group or a home exercise-based program and will soon be able to be claimed through Private Health Insurance (depending on level of cover). For more information, please go to www.dancewright.com.au and / or contact me here.
Source: Journal of Dance Medicine & Science, Volume 26, Number 4, December 2022, pp. 213-225(13)
Publisher: J. Michael Ryan Publishing Inc.