Why all the injuries in elite ballet students?

Ballet dancer

Recent study on why elite teenage ballet students are highly prone to injury and what can we do about it.

A recent article in the 'Journal of Science and Medicine in Sport' titled Injuries in pre-professional ballet dancers: Incidence, characteristics and consequences suggests that elite, pre professional ballet students age 15 - 19 years are at a higher risk of injury than than other elite athletes of a similar age.

On average they are each getting 1.49 injuries and have a 76% increase in injury over a one year period.
The ankle was the most commonly injured body part and overuse injuries (as oppposed to accute) were they main type of injury.


I would say that the cases are many and include but are not limited to the following:

  1. The high level of training, the repetitive nature of the work and hours involved in class, rehearsals and performance.
  2. Ballet in general is becoming a lot more athletic and acrobatic.
  3. The lack of resources (mostly time) to provide a wide variety of alternative, compatible conditioning training.
  4. A pre professional student is prone to ignoring a minor injury or niggle and will often hold off on seeing a physical therapist of some form until the injury is rather serious.
  5. Peer to peer competition and staged competitions where the dancers try to out do each other with the latest trick or flick, to impress upon others to receive awards, scholarships or secure one of the few places available in a company.
  6. The students may be carrying a minor tear or have a bad habit developed prior to entry into the elite dance training facility and the workload and competition has caused a bad injury to develop.

The injuries identified in the article that took the longest to heal were bony injuries:

1. Stress Fractures of the foot - due to pointe work and weight bearing work load.
When a dancer does a lot of jumping (petit allegro and grand allegro) on her hyper-mobile and flexible feet, which are not the best of shock absorbers, this causes the bones and tendons to take the impact of the jump and over time stress fractures will result.


  • From a young age strengthen and articulate the muscles of the feet and calf muscles in fun and novels ways.
  • Wait until the dancer has reached puberty before commencing pointe work.

2. Knee Injuries - due to forcing external rotation from the feet rather the hips.
When a dancer constantly works to try and increase her turnout by pushing the toes backwards rather than using the external rotators at the top of the leg and hip, the alignment of the knee moves forward whilst the toes push backwards and the arch of the foot collapses forward.
The alignment of the knee should be directly over the centre of the foot when bending especially on one leg in a fondu. If the dancer is unable to maintain this alignment especially on one leg or landing from a jump this causes medial strain on the knee and over time a tear or debilitating injury.


  • Let go of always have to work in turned out positions.
  • From a young age and increasing in frequency as the child gets older work on strengthening the external rotators of the leg in non weight bearing conditioning sessions.
  • From a young age through to 12 years and beyond spend a lot of time working in parallel, especially when landing from jumps in the allegro section of the class.

At Big Steps Little Feet we work a lot in parallel, from learning to plie as a 2 year old to learning how to land big jumps as 9 or 10 year old. What I believe is the most important is understanding the action, feeling and mechanics of the skill being learnt and how to perform it with artistry. I believe this is best learnt in the parallel alignment with knees over toes when bending. I call this ‘beta mode’ a super safe way to get the skill right before exposing the body, muscles, tendons and ligaments to the more stressful external rotation alignments.

Kate x

Source: Injuries in pre-professional ballet dancers: Incidence, characteristics and consequences
Christina L. Ekegren, Rachele Quested, Anna Brodrick 
Journal of Science and Medicine in Sport - May 2014 (Vol. 17, Issue 3, Pages 271-275, DOI:10.1016/j.jsams.2013.07.013)