Readiness for En Pointe Work in Young Ballet Dancers; Are There Proven Screening Tools and Training Protocols for a Population at Increased Risk of Injury?

Written By Tara Christensen

Altmann C, Roberts J, Scharfbillig R, Jones S. “Readiness for En Pointe Work in Young Ballet Dancers; Are There Proven Screening Tools and Training Protocols for a Population at Increased Risk of Injury?” J Dance Med Sci. 2019;23(1):40-45

Purpose: To evaluate the available evidence relating to readiness for dancing en pointe, including injury rates in the adolescent dancer population, screening tool, and pre-pointe training methods.  

Type of study: The type of study was a literature review.  After distilling down search results the study utilized a total of 27 studies; 26 peer reviewed journal articles and one editorial.

Relevant findings:

  • Forces en point through the foot occur at up to 12 times the body weight of the dancer.

  • Criterion other than chronological age should be used to determine pointe readiness.

  • Typically an age of 12 would be a criterion for initiating pointe work.

  • Currently no standard criteria established.

The study talked a lot about injuries in dance.  They found that the majority of the studies suggested that the greatest amount of dance injuries occur during adolescence with one of the included studies finding the average age of injury 13.3 years of age.  Some of the proposed reasons for increase in injury from younger age to teen were:

  • Increase in training hours

  • Pre-Pubertal growth spurt

  • Extending joint range of motion for better performance

  • Type of exercise (such as dancing en pointe)

They reported that the same article highlights that the greatest number of injuries compared to hours of training per week occurred in the 11 to 13 year old age group.

Several articles proposed that adolescent dancers are at a high risk for overuse injuries, typically as a result of functional overloading, with growth spurt seen as a physiological risk factor.

All of the above information was used to illustrate the importance of medically driven screenings for injury risk reduction in dance.  Screenings can uncover pathology and quantify risk, determine criteria necessary for participation in things like pointe work and establish individual baseline data for educational and rehabilitative goal setting.

One study (Meck et al, “Pre-Pointe Evaluation Components Used by Dance Schools”.  J Dance Med Sci.  2004 Jun;8(2):37-42) used in the review did a survey of 74 American dance schools found that there were 8 commonly used pre-pointe evaluation components:

  • Age (Most commonly reported - range from 9-13 years)

  • Years of Dance Experience

  • Present Injuries

  • Past Injuries

  • Releve alignment and stability

  • Plie alignment and stability

  • Tendu strength

  • Activation of the intrinsic foot muscles

  • Upper body alignment and stability

    Another study (Richardson et al, “Functional criteria for assessing pointe readiness.” J Dance Med Sci. 2010;14(3):82-8) compared nine pointe readiness tests with teacher classification.  Although no statistical significance was show the Saute test, Airplane test and Topple test did correlate with teacher classifications.

    Yet another study (Shah, S.  “Determining a young dancer’s readiness for dancing on pointe.” Curr Sports Med Rep. 2009 Nov-Dec;8(6):295-9) noted that the radiographic appearance of growth plate closure does not correlate with the completion of boney maturation (which occurs later in the teenage years).  Therefore, it is not appropriate to use x-rays to determine pointe readiness.

    Shah also proposed that a full history and physical examination should be included in the assessment of pointe readiness, which includes:

    • Age

    • Teacher recommendations

    • Years of dance training

    • Hours of training per week

    • Dance goals

    • Difficulties with specific technique in class

    • Injuries both past and present

    • Measures of plantar flexion range of motion

    • Assessment of first, second and fifth position and any compensations observed

    • Releve (in multiple positions)

    • Alignment 

    • Passe

    • Grand Plie

    • Topple Test

    • Airplane Test

    • Saute Test

      Conclusion:  Dance screening is seen as a valuable tool to use to evaluate aesthetics, technical strengths and weaknesses as well as medical and physical issues; however further research is needed to develop standards for pre-pointe screening and training protocols.

Tara Christensen
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Functional Criteria for Assessing Pointe-Readiness