Teen ballet dancer doing stretches A physical therapist trained in dance medicine works with a young male dancer in clinic Ballet dancers embody fluidity and grace. But what looks effortless on stage requires countless hours of practice and training. Like any athlete, ballet dancers are prone to injury, and young performers who are still growing are especially at risk.

“Dancers who are going through puberty may experience issues because of their rapidly changing bodies,” says Naomi Brown, MD, FAAP, CAQSM, an attending physician with the Sports Medicine and Performance Center at Children’s Hospital of Philadelphia (CHOP).

Common ballet injuries and their causes

Overuse injuries like stress fractures and tendonitis are common among ballet dancers, who perfect their skills by practicing them over and over. Dancers are also at risk for acute injuries like sprains and torn cartilage.

Common ballet injuries can affect any part of the body, commonly the back and lower extremities. Below is a list of the most common ballet injuries and how they occur.

Back injuries

Spondylolysis — a stress fracture in a vertebra in the lower spine — is caused by repeatedly extending the back. This common injury for dancers causes lower back pain, which increases when the individual arches their back, jumps, runs or is lying flat on their back.

Hip injuries in dancers

The physical demands on a ballet dancer’s hips can cause labral tears or snapping hip syndrome, sometimes called dancer's hip. In snapping hip syndrome, the dancer may feel or hear a snap when a tendon or muscle moves over the front or side of the hip. This may or may not cause pain. A tear of the labral, a soft tissue structure that rims the hip socket, can cause pain and stiffness in the hip.

Leg injuries

Repeated jumping can cause stress fractures in the lower leg bones (tibia and fibula). Less common among ballet dancers are stress fractures in the thigh bones (femur) and pelvis.

Knee injuries

Pressure from bending, jumping and performing plié (a common movement in dance) can cause patellofemoral pain syndrome. This can lead to softening or thinning of the cartilage behind the kneecap, resulting in a dull, achy pain. Dancers who hyperextend their knees while dancing en pointe (on their toes) are prone to stress fractures and knee sprains.

Foot and ankle injuries in ballet dancers

Repeated impact, with jumping or turning, may lead to fractures in the foot, often called a dancer’s fracture. Ankle sprains are also a risk if the ankles turn inward while dancing en pointe. Other common overuse injuries for ballet dancers include inflammation of the Achilles tendon, which links the calf muscles to the heel; and inflammation of the flexor hallucis tendon, which flexes the big toe.

Approximately 15-20% of the population have an extra bone in the back of their ankle (os trigonum). Dancers with this extra bone may suffer painful impingement in the back of the ankle, especially with relevé or en pointe. Ankle impingement can also occur in the front of the ankle when the tissue is pinched during pliés and jumps.

The importance of nutrition for young ballet dancers

Slender bodies are the ideal in ballet, and the pressure to be thin can lead to eating disorders, particularly in female dancers. Dancers who don’t take in enough calories and nutrients are at higher risk of injuries and mental health concerns. Signs that a dancer isn’t getting proper nutrition include delayed menstruation, fatigue and weight loss.

“Nutrition is #1. Even if you’re not injured, that’s important to know for your career,” says Kathleen J. Maguire, MD, an attending physician with the Sports Medicine and Performance Center at CHOP.

Preventing ballet injury

Parents and instructors can help young ballet dancers stay healthy and injury-free by setting limits.

“There’s a lot of ‘pain is gain’ thinking in the dance world,” says Dr. Maguire. But pain is an important warning sign that may lead to problems if ignored. While soreness after a workout can be normal, persistent pain should be checked by a healthcare professional.

Other ways to avoid injury include:

  • Crosstrain with other forms of dance to avoid overuse injuries.
  • Work with a physical therapist familiar with ballet. A physical therapist will pinpoint and correct poor technique and other problems that could lead to injuries.
  • Eat for peak performance. A nutritionist can work with dancers on proper nutrition. 

Prevention is key to staying healthy. But when injuries do happen, the quickest way back in the studio is to seek treatment from professionals who understand the unique needs of ballet dancers.

“A lot of time dancers don’t consider themselves athletes and don’t realize they can be seen by a specialist in sports medicine,” says Dr. Brown. “We love treating performance athletes and are focused on getting them back to their craft!”

Dance Medicine is an area of expertise at CHOP’s Sports Medicine and Performance Center. Youth and adolescent dancers, both male and female, can find dance-specific physical therapy, general sports medicine care, sports nutrition and orthopedic surgery consultations. We’re here to help prevent dance-related injuries and return dancers to activity as soon and safely as possible after injury.

Contributed by: Naomi Brown, MD, FAAP, CAQSM, Kathleen J. Maguire, MD, and Heather F. Stewart, PT, DPT, SCS

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