Pointe' Ballet Evaluation Description and Necessity
Pre-Pointe Evaluation Form (Long Version)
Pre-Pointe Evaluation Form (Short Version)
Ballet- conditioning and strengthening
Ballet is a sport of artistry and strength. It is a pure combination of motion and stability. There are many studios that focus on progression of elements rather than basic knowledge of positioning and technical performance. Technical performance includes making sure that proper positions that are reached, whether arabesque with focus on back and leg, or simple turn out, focusing on hip, knee and ankle alignment. Unfortunately, without flexibility training as well as core stability, advanced ballet cannot be performed properly, and technique will only continue to diminish throughout the years due to bad habits and a poor base of support.
When progressing the dancer from basic barre' work to the process of pointe', there are many concerns to address.
Why are we concerned about Pointe' too early
It seems as if there is a split between goals and energy focused on advancing the dancer. From a parent perspective, health and longevity in the sport should be the main focus, which would lead the instructor and medical advisor to understand that the dancer rises to pointe' once the body is ready. Unfortunately, some parents live vicariously through their children and want to be able to claim that their daughter is “good enough” to go en pointe'. Sadly, these early risers often are plagued with injuries that disallow continuation of dancing, or interrupt the technical development of the dancer. From an instructor's perspective, there is pressure from the parents to advance the child, and it takes a confident and well developed program to make sure that advancement happens only when ready. With local community competitiveness and word of mouth, some parents seem to value schools that have large amounts of children en point' and young at that. This is a poor motivating factor for studios to advance early, and should be shunned rather than revered.
Besides the common knowledge of sloppiness and poor technique as a result of early pointe', there are medical concerns that, if not curbed, will last a dance career and unfortunately the lifetime of the dancer.
How do we know she is ready?
Proper pre-pointe' evaluations need to be completed by a qualified health care professional. The public often believes that physicians are the best to ask, however, less than 2% of orthopedists and foot doctors are familiar with the requirements of dance, from a technical perspective or a physiological development. Lower than number when you think of how many physicians are specifically knowledgeable of adolescent bone and ligamentous development issues.
Age. Research has been done for years, short term and long term studies, on injuries that dancers attain depending on years in dance, age starting pointe' and more. The cumulative intelligence of the dance medicine community has determined that younger than 11 is too high of a risk. Depending on which factors one deems as more important than the next, age can be a factor, or just a milestone to be reached. I have found some 12 year olds who meet all the requirements, and then some high school aged athletes who may think they are ready, but because of quality of instructor or body factors, are not. This is why it is very important to complete full evaluations.
Bone Maturity. Although studies can give you an average, each dancer matures at a different rate- from estrogen production, to bone formation, growth plate closure, body style, Q-angle development, and more. A combination of communication with medical advisor and instructors, dance observation, strength testing, flexibility assessment and x-ray films is the best way to determine alignment and readiness
Flexibility. If the dancer cannot rise to full pointe' position, then the line of gravity is not proper. When bones sit properly on top of one another, weight bearing is dispersed with the least amount of demand of muscles to stabilize the joint. If the dance cannot properly “pointe'”, or plantar flex the foot and ankle, then the muscles in the back of the calf, such as the gastroc, soleus, posterior tib, peroneals, and the Achilles tendon, will be predisposed to overuse injuries.
Strength. The dancer needs to have the proper strength not only in the ankle, but also the intrinsic musculature of the foot. Strength needs to be measured all the way up the kinetic chain to the high ankle, knee, hip, spine and abdominals. A combination of coordinated strength from the belly button down is what created the highest predisposition to success due to core stability, hip positioning, knee strength to maintain center of gravity alignment and create the least amount of muscle strain on the ankle and foot.
Balance. Balance testing is very important for readiness as well as setting the athlete up for the highest amount of success with training. When transitioning from flat foot to demi-pointe', one goes from 100% foot effacement with ground to 25-30%. When transitioning from demi' to full, this decreases again by more than 50%. It is of utmost importance that balance is worked on from the day that a dancer starts, even if they are only 3, to establish muscle communication, special awareness, development of small foot and ankle stability muscles and more. This can be as simple as standing on one foot, to advanced platforms for variable stability challenges.
Body Awareness. Does the dancer know how to move fluidly? Is there a joint separation that can take place (keep the core and knee stabile while allowing changes in the ankle?) Can the dance pirouette on releve', concentrating on spine, hip and knee positioning without losing focus on static releve' position in the foot and ankle? These are necessary skills that the athlete must possess in order to be able to focus on arm, spine, and leg motion while en pointe'. A lack of focus, or subconscious maintenance of positioning, will lead the dancer to a predisposition to injury.
What is the process for the evaluation?
The medical advisor will meet with the staff to describe the process. Dancers already in prep classes will be evaluated individually or as a group, depending on the numbers. Evaluations can be done in quick/mini, standard, or extended. Extended evaluations can take up to 2 hours, quick can be done in as little as 10-15 minutes, but is not as all-encompassing or accurate by any means. Sometimes, studios want to simply get a gauge of a group, and then select individuals that need further assessment when the time to actually rise to point' comes closer. Measurements are taken for flexibility with a goniometer, to measure angles. Strength is measured by manual muscle testing, function, and sometimes using equipment. Balance is checked single leg standing, various surfaces, eyes open and closed (to mimic function/focus). Results will be shared with dance studio/instructors, and the families. This can either be a determinant of progression, or a baseline, which is extremely helpful in repeat testing, to check progress and success of pre-pointe' programs.
An MD may be called in to the process to determine ankle health or foot health if there are concerns or pains. Films can be taken to view toe bone alignment, including valgus deformities, bunion development, and ankle range limitations that may be from soft tissue or bone abnormalities. Growth plate relative closure can also be determined. When rising to point', pains often occur in the first year including Blisters, toe nail issues, great toe joint inflammation, calf pain, Achilles tendon irritation, heel issues where calf attaches, ankle sprains if loss of balance occurs, plantar fascia irritation, and more. If this occurs, contacting your medical advisor first, as long as it is not an emergency, is the best option. They can review your pre-pointe' evaluation, note the issues, as well as check for trends. Trends can be found if the athlete was cleared for pointe' but still was struggling with plantar flexion range issues, and now has anterior ankle pain- this is to be expected, and now we may know that range of motion is more of an issue than previously anticipated.
As well , bone age can be determined with films, too. For instance, some athletes, due to poor development, nutrition, hormonal imbalance, and other factors, may not develop as quickly as they age. This is important in the feasibility of pointe' dance, making sure that the athlete's bones can handle the new positions of stress.
The most important factors in dance success are 1) quality of dance instruction, 2) treatment of the dancer as an individual, and 3) the communication between, the dancer, studio, medical advisory and dancer's family. Keeping all of this in mind, no good genes or strong body part can replace good, quality and technical education. Above all else, unmeasured, is patience. The body is a machine, which is performing an art. Time, fine turning, and development will allow a dancer to be the most beautiful they can be, and the healthiest. Best wishes in your development, and remember, you only get one body, one spine, two feet, ten toes, and one chance… make it a good one.
More about ballet coming soon!
Here, you will find information on:
- Irish Dance Injury Prevention
- Irish Dance specific stretching
- Irish Dance strength programs
- Publication in Irish Dance and Culture Magazine
- and more!
Please visit the pages of this website for Q/A, articles, and great downloads of stretches and other programs!
Of course we are always available for Education and Treatment of the Irish Dancer. We can do this for groups, studios, dance organizations, specific groups in prep for a Feis, or individuals. Please contact Gina for further questions!
Irish Dancing Injury and Rehabilitation Questions and Answers
Most of these questions came from emails to IDC magazine, to Gina, or through forums/chats. Here are some answers that I hope will help! If you have a question to be answered that will help you and others too, email Gina at firstname.lastname@example.org
About Irish Dance Performance
It’s St. Patrick’s Day and dancers are running full steam from show to show. What are your tips for staying healthy?
It is important to realize that you have to “apologize” to your body for the extra pounding and hours on your feet! Treat yourself well and make sure you are getting extra sleep, making sure you are eating something after dance to help your muscles recover (with some carbs, extra protein and a little fat), and drinking plenty of water. Water helps to flush your system of toxins and keep you feeling fresh!
Dancers often perform on poor surfaces during shows, as many are in local gyms, restaurants, etc., What is the best way for them to prevent injury?
Hard surfaces are always a contributor to injuries such as plantar fasciitis, heel pain, shin splints, and swelling in the feet and ankles. It is because there is no shock absorption (or very little, depending on the surface). It is important to stretch your calves, bent knee and straight knee, after every practice. Also, rolling out the bottom of your foot with a wooden roller you can purchase, or a plastic water bottle filled with ice, will help to massage the muscles and take care of a little inflammation. Most of all, wearing sensible shoes off-dance time is the most important. Shoes with proper soles, good arch support, and cushion. Especially around this time of year, make sure there is arch support in your boots. If there isn’t, you can buy an over-the-counter orthotic to help take care of your feet. Also, avoid walking barefoot in the house, especially on hardwood floors. Seeing a physiotherapist regularly for work on the calf and foot muscles will help. Massage occasionally will take the tension out of the tissue… so many options!
What should a dancer do if they feel any pain in their legs or feet?
There are questions to ask yourself with the pain. How long has it been there? If it is lingering for a few days, and rest does not seem to help, get an injury screen by a physiotherapist and they can direct you to the best doctor to help you out, then you are making sure your time in the doc’s office is well spent with the right people. You may not have to go the MD and you may be given exercises at home to help. However, there are 5 reasons to go to see your physician sooner, rather than waiting. Those are: bruising, swelling, throbbing, sharp pain, or being unable to walk properly. If you can’t walk, you can’t dance!
About Irish Dance Medical Care
As an Irish dancers what can a Physical therapist offer me?
PT can do injury evaluation, strength analysis, flexibility assessment for sport-specific things (such as hip turn out and sacral balancing for more open and higher cuts, core stabilization for better control in dancing and lower extremity motion, foot and ankle health with overuse injuries such as plantar fasciitis and ankle tendon overuse. With the ART, we are also able to provide constant pre-injury care to make sure that the body is balanced and biomechanical alignment is as perfect as it can be.
How does your work differ to a chiropractor or doctor, specifically for Irish Dancers?
Chiropractors, traditionally, adjust the spine and body parts, but tend to ignore muscle imbalance, and why the bones were out of place in the first place! Without muscle reeducation, the body will go back to where it was. If the muscles are being used improperly, because of biomechanical imbalances, the biomechanics have to be addressed first, then the secondary problem treated. Physicians see patients and do one of 5 things: 1) surgery, 2) oral medications, 3) injected medications, 4) advice for rest and conservative treatment, which does not heal anything in essence unless the problem is addressed, and 5) send to PT! Often, because of time limitations, physicians do not have the time to give appropriate exercises, and if a generic sheet is given, it is not tailored to the client. PT’s can spend 1-3 visits with someone (not overwhelming) and then really tailor the program. In addition, there are many techniques that we do, such as Graston, ART, soft tissue work, joint mobilization, etc, that MD’s are not aware of, and how they help things (example: plantar fasciitis will never get better with rest, ice and anti-inflammatories-the tissue needs to be worked on, the inflammation reduces from a soft-tissue perspective, and the biomechanics that created the problem addressed!
How do I know what type of therapist I should go and see for an Irish Dance Injury?
A PT that has experience in Performing Arts Medicine is the key – we have years of experience that lead us to be able to differentially diagnose problems that some other PT’s and physicians miss, due to the inherent nature of dance medicine! Manual therapy is what dancers need, no step downs, bike, ultrasound, and stim! A PT should spend 30 minutes ONE ON ONE with you in the clinic to get the proper care. If we are too far for you, we can set you up with someone. Be cautious of PT organizations that say that they have a program, and make sure that you see the PT’s that are the experienced ones!
What is the most common dance related injury you treat for Irish Dance?
Irish dance- plantar fasciitis. The shoes are too tight, the toes curl, kids wear flip flop shoes, they do not stretch their calves, and they are overworked! the fascia gets tight and adhered to the other layers on the bottom of the foot (quadratus plateau, deep toe flexors, fascia) and the problem escalates to dancing differently, tight calves, and improper toe flexibility. This is a KEY treatment for us, and one of our specialties!
Do you treat many Irish dancers?
We have had over 30 this year alone, in one location, that is ALOT! We also have relationships for referrals with 6 different dance studios, and consult with those that are too far. The hour or more drive for an evaluation is worth while when it comes in comparison to the potential health care cost if the injury gets worse, or the wasted time with a larger PT group that does not specialize. We know how busy kids and parents are, and only treat as needed! We see people from anywhere from 10 minutes away at a local studio to 3 hours, driving in for consultation for dance programs- stretching, at home rehab, or simple opinions on biomechanics and alignment.
If there were 10 things young Irish dancers could do to prevent injury what would they be?
1) Stretch every day.
2) core stability exercises, dance-specific
3) Do not wear your shoes too tight.
4) Do not wear flip flops- they do not support your feet and encourage plantar fasciitis!
5) Sleep, for recovery.
6) Drink recovery drinks, such as Power Bar, Endurox, or other brands to allow for faster muscle healing.
7) Hold your stretches for at least 45 seconds to allow for long term benefit.
8) See a PT for injury screen, and let them direct you to a physician that is the post appropriate. They know the good ones, the bad ones, the specialists, those who are good with certain ages, certain injuries, when to see an orthopedic or a podiatrist and more. Use their experience to help you!
9) Constantly communication with your dance studio’s medical liaison, or call Gina for any questions or direction
10) Listen with caution to the advice of other parents, web-based one-size-fits-all programs, and fad medical cures- manual therapy, time and rest are still the best!
I am an Irish Dancer and I am always getting shin splints when I practice, how can I stop this?
Calf stretching is very important. Shin Splits, which are true fractures of the tibia, are often not the case! Most likely, it is the Soleus, a deep calf muscle that is aggravated around the front of the shin, where it wraps to attach. Some deep ART and flexibility will help, as well as muscle balancing on the front, like toe lifts!
I pulled my arch on Saturday during my 1st round of dancing. it hurt pretty bad today to dance on. I was on stage and wanted to cry, it was twinging so bad. it’s not just a normal sprained pain either- it’s a pulled muscle pain. i was wondering if anyone knew of any stretches for your arches so that i can avoid doing this AGAIN! ( i have done it more than 10 times this year but never quite as painful)
Arches can be stretched, but it is difficult to do on your own! You need to sit with your foot in front of you, and flex your foot (dorsiflex – opposite of point) as well as pull your toes back and extend them. When you do this, you can’t let the ball of your big toe drop down – part of stretching the arch is to also stretch the big toe motion, too! Stretching the calf is important as well, as it attaches to the heel from the back, and the arch muscles attach from the bottom. When one or both are tight, they play a tug-of-war with the heel, often throwing off biomechanics! The two calf stretches are really important to do, bent knee and straight knee.
There are also rollers that can be purchased for the bottom of the foot, to dig in deep and loosen the tissue (like at home massage!). A PT can get them for you, and they are much better than a golf ball or a water bottle…
Again, this sounds like plantar fasciitis or a muscle tear or sprain. The only way to properly diagnose is by films such as MRI or CT scan, and diagnostic ultrasound. Rest will not ever cure muscle strain – the scar tissue will still be there! You need to see a PT that will do manual therapy on the bottom of the foot, and calf, as well as toe flexibility and the intrinsic (little and mighty) muscles of the foot and ankle.
Does anybody have any advice on how to speed up the recovery of a twisted or sprained ankle or some strengthening tips? Cause I have a feis this weekend and I’m so close to recovery. I sprained it 5 days ago.
Ankle sprains happen from trauma or as a result of hypermobility or instability – both of which need balance and stability exercises, as well as manual therapy such as ART and Graston Technique. They are both really helpful in taking the swelling out soon, which makes the ankle feel less stiff. These, of course, are things done by professionals in health care like PT, MD’s, etc, and need appointments, scripts. As you know, MD’s are hard to get in to! So, massage works well as a adjunct too, which is often easier to get into. If you self massage, go from distal to proximal (toes to hip) to flush out and drain. You can take anti-inflammatories (always consult physician before taking medication and never take without parental supervision). You can also wrap the ankle with elastic that is tight enough to compress, but loose enough to fit two fingers between the wrap and your skin!
Exercises for ankles – there are a ton! You can do them as prevention, and that will work well in the long run
See Powerpoint for quick, easy Irish Dance specific stretches
What is the best way to loosen up my legs? I want to be able to get higher on my kicks and leaps but just can¹t get my legs high enough?
Higher kicks requires hamstring flexibility (the muscle that is in the back of your leg) and leaps require hamstring for the front and hip flexor for the back (the muscles that goes from your spine to your thigh, in your groin and front pelvic area). See the stretching set for Psoas and quads and hamstrings to help with this! Always hold stretches for 30-45 seconds, and never “bob” or you may tear something.
I have been off with an injury for about 2 months, I was not allowed to do ANY exercise and obviously now I am very unfit. Please give me some ideas on how to get fit and flexible again, as I have always been fit and this is the first time I have to start from scratch !Any ideas would be very much appreciated!
Depends on the injury – if it is lower extremity, go slow – the bones are not used to weight bearing and pounding, so the best way to return is by difficulty of dance skills and time (start 15 minutes, with 15 break, then 30 to 15 break, then 45 to 15 break, then 1 hour no break and so on..). Let pain be your guide, if it hurts – stop! It is your body telling you it is not quite ready for whatever you are doing!
I hope this helps you make it through this busy time. Remember, your body is a well-oiled machine when it runs right! Water to flush it out, proper food to give it energy, rest to recover, and cross training (stretching, balance exercises, strengthening) to prepare it to handle anything. Take care of your feet- they are the only ones you have! Remember to consult with your physician or therapist before trying anything on your own.
Irish Dance Treatment
The treatment of Irish Dancers is very specific to the needs
We offer programs that include:
- specific joint assessment
- body balancing
- core focused conditioning
- balance/stability for ankles/core
- foot health
- jump height training
- and more
1) Achieve Orthopedic Rehab Institute, 7055 South High Grove Blvd, Burr Ridge, IL 60527
This location specifically has Irish Dance and Performing Arts Specialists.
2) At your own studio/gym or arena, please call Gina to arrange setup
See link below for PDF advertisement of services offered:
Irish Dance Medical Treatment Outreach Flyer
Irish Dance Medical Treatment Ad
We can come to you!
- Injury evaluations on site
- Weekly/monthly or otherwise arranged
- consultation before major Feis or performance
- In-kind relationship (use us when you need us)
- We would be your Official Medical Sponsor and filter you to the proper physicians and ancillary medical staff such as nutrition, podiatry, orthopedic, spine health, chiropractic, massage, etc.
- Please contact Gina for more information.
We are going to be putting on an Irish Dance Medicine Seminar/Course for instructors, to educate on:
- Injury knowledge for proper advice/referrals
- return to injury after being out
- prevention- ankle health, knee, hip, spine
- positioning of the lower extremity for proper biomechanics
- core stabilization/strength
- flexibility- daily, weekly, and periodic
- jump height/explosive leg power
Please email Gina if you would like to be on the distribution list for the course!