Assessing Readiness for En Pointe in Young Ballet Dancers

NewsBot · Jan 24, 2016

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Assessing Readiness for En Pointe in Young Ballet Dancers
Jeffrey C. Lai, MD; David W. Kruse, MD
Pediatric Annals; January 2016 - Volume 45 ? Issue 1: e21-e25 (full text)

Children begin ballet lessons as young as age 2 years. The graceful movements of classical ballet require a combination of artistry, flexibility, and strength to perform. During the training and development of a young ballerina, the transition to dancing en pointe (?on the toes?) represents a significant milestone and traditionally begins around age 11 or 12 years, assuming the proper training background and dance aspirations. However, current dance medicine literature describes factors such as maturity, proper technique, strength, and postural control as the more significant factors in determining pointe readiness. An in-office evaluation of these factors can be performed by the clinician to assist dancers, their family, and their dance instructor(s) determine pointe readiness
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Admin2 · Jan 24, 2016

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NewsBot · Mar 4, 2016

Specificity of foot configuration during bipedal stance in ballet dancers
Antonino Casabona, Giuseppa Leonardi, Ettore Aimola, Giovanni La Grua, Cristina Maria Polizzi, Matteo Cioni, Maria Stella Valle
Gait and Posture; Article in Press

Highlights
•Benefits from ballet training were tested for stances with different foot positions.
•Dancers had benefits for a familiar foot position, regardless the stance difficulty.
•Specificity regarded both the stability and the structure of the postural control.
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Learning highly specialized upright postures may be of benefit for more common as well as for novel stances. In this study, we asked whether this generalization occurs with foot configurations previously trained or depends on a generic increase in balance difficulty. We also explored the possibility that the benefit may concern not only the level of postural performance but also the structural organization of the upright standing. Ten elite professional ballet dancers were compared to ten untrained subjects, measuring the motion of the center of pressure (COP) across a set of five stances with different foot configurations. The balance stability was measured computing the area, the sway path, and the root mean square of the COP motion, whereas the structure of the postural control was assessed by compute approximate entropy, fractal dimension and the mean power frequency. The foot position included common and challenging stances, with the level of difficulty changed across the configurations. Among these conditions, only one foot configuration was familiar to the dancers. Statistically significant differences between the two groups, for all the parameters, were observed only for the stance with the foot position familiar to the dancers. Stability and structural parameters exhibited comparable differences. We concluded that the benefit from classical ballet is limited to a specific foot configuration, regardless of the level of stance difficulty or the component of postural control.
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NewsBot · Mar 11, 2016

Dynamic evaluation method of lower limbs joint alignment (MADAAMI) for dancers during the plie
Kaanda Nabilla Souza Gontijo et al
Revista Brasileira de Ciencias do Esporte 5 March 2016

In classical ballet, the joint misalignments during the plie can generate various injuries. To evaluate potential misalignments during the pli? the aim of this study was to present a method for dynamic evaluation of lower limb alignment articulation (called MADAAMI). MADAAMI was validated by 12 experts, and for the evaluation of its reproducibility and for agreement with 3D kinematics, 20 dancers were assessed using a video recording of their pli?. For statistical analysis we used the Kappa coefficient (k) (p < 0.05) and percentage agreement (C). We conclude that MADAAMI had satisfactory reproducibility and intra-rater agreement with 3D kinematics (k > 0.40 and C > 80%), and it is a suitable and valid method for use by the same examiner.
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NewsBot · Nov 16, 2016

Fitness Testing to Determine Pointe Readiness in Ballet Dancers
Hewitt, Shayla et al
Journal of Dance Medicine & Science, Volume 20, Number 4, December 2016, pp. 162-167(6)

Pointe work requires substantial physical ability and effort. However, no standard measures exist to determine when a dancer is ready to begin to dance en pointe. This study explored whether physical tests could discriminate between pre-pointe, beginner pointe, and intermediate pointe students. The secondary purpose was to determine if teacher ratings of dancer performance and experience aligned with test scores. Twenty-nine female ballet students from two dance studios participated in the study (age: 13 ± 3 years; height: 155.7 ± 13.7 cm; weight: 50 ± 14.6 kg). They were divided into three skill groups: pre-pointe (N = 12), beginner pointe (N = 7), and intermediate pointe (N =10). The participants completed five tests (heel rise, plank, sauté, topple, and airplane) used to measure physical attributes important to pointe training. In addition, the students' teachers rated each participant based on her ability to successfully complete all pointe work given for her level or, if she was a pre-pointe student, according to whether she was physically progressing at the appropriate rate to begin pointe. The findings of this study indicate that three tests (airplane, topple, and sauté) have some value in discriminating between dancers of different skill levels and may be useful for determining pointe readiness.
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NewsBot · Nov 23, 2018

Quantitative Measures Utilized in Determining Pointe Readiness in Young Ballet Dancers.
DeWolf, Andrew; McPherson, Alyssa; Besong, Kathryn; Hiller, Claire; Docherty, Carrie
Journal of Dance Medicine & Science . 2018, Vol. 22 Issue 4, p209-217. 9p.

While an important step in a young dancer's ballet career is the transition to pointe work, there is much controversy as to when her body is physically prepared to meet the increased demands of this development. Pointe screening protocols are being used by many in both the dance studio and dance science communities, but these protocols have not yet been standardized. The purpose of this study was to evaluate objectively the attributes of ballet dancers who are pre-pointe compared to those who have recently begun pointe training, and secondarily to correlate these quantitative findings with qualitative evaluations by the dancers' teachers. Participants were 49 healthy young female dancers with at least 1 year of formal ballet training. Twentyeight were pre-pointe students (age: 10.21 ± 1.17 years; height: 124.05 ± 13.45 cm; weight: 39.13 ± 13.18 kg; and 6.04 ± 1.84 years dance experience), and 21 were pointe students (age: 11.42 ± 0.81 years; height: 136.91 ± 16.04 cm; weight: 40.79 ± 8.77 kg; and 6.45 ± 2.07 years dance experience). Six dependent variables were evaluated: non-weightbearing (NWB) plantar flexion (PF) and dorsiflexion (DF) range of motion (ROM); weightbearing lunge test (WBL); relevé endurance (heel raise test); PF isometric strength; Airplane test; and Star Excursion Balance Test (SEBT) in three directions. These tests were broken into three categories for statistical analysis: ROM (NWB PF and DF, WBL), muscular capacity (relevé endurance, PF isometric strength), and balance (Airplane, SEBT). The analysis demonstrated that the pointe group performed significantly better than the pre-pointe group on the muscular capacity and balance testing (p < 0.01). Calculations for both tests indicated that 15 continuous single-leg relevés and two repetitions of the Airplane test may be the best cut-off levels when using these tests as part of a pre-pointe screening protocol. In conclusion, the relevé endurance test and the Airplane test are appropriate for use in differentiating between pre-pointe and pointe dancers.
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NewsBot · Feb 25, 2019

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?
Altmann, Carlie et al
Journal of Dance Medicine & Science, Volume 23, Number 1, March 2019, pp. 40-45(6)

To progress to a high level in classical ballet, en pointe is a requirement. The aim of this literature review was to evaluate the available evidence relating to readiness for dancing en pointe, including injury rates in the adolescent dancer population, screening tools, and pre-pointe training methods. It has been emphasized that young dancers are a demographic at increased risk of injury, especially as they progress through the growth spurt and increase their training hours. Dancers are commonly screened at the pre-pointe level, but unfortunately the majority of evidence resulting from this process, as reported in the literature, is subjective in nature. Hence, there is large variance regarding an appropriate time or level to commence en pointe training, and it remains unclear what dance teachers should be looking for in making this decision. A further paucity of evidence is demonstrated with regard to pre-pointe training protocols or instruction; in this review, no published literature was found on the topic. As such, there is a clear need for further study of pre-pointe screening and en pointe training protocols.
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NewsBot · May 18, 2019

Results of a Six Week Training Protocol for Dancers to
Achieve Pointe (Toe Shoe) Readiness
Marijeanne Liederbach et al
ACSM ANNUAL MEETING
May 28 – June 1, 2019 – Orlando, Florida

PURPOSE: It is estimated that 2 million children study dance each year in USA
public schools alone, and that more than 35% of all adolescent girls participate in some
form of dance training. Their most common injury is ankle sprain, with recurrence
as high as 80%. This study aimed to test the efficacy of a six-week, pre-pointe (toe
shoe) progressive training program that, if effective, would subsequently be put into a
3-year prospective epidemiologic study examining the intervention’s effect on ankle
sprain rate. METHODS: 16 pre-pointe students, (average age 11 yrs), at a professional
ballet school assented, (along with parent/guardian consent), to participate. Three
motor control-based concepts were incorporated into a 50 minute progressive exercise
class taught twice per week for 6-weeks. The motor control principles underlying all
of the exercises were: 1.) identification and maintenance of trunk-pelvic neutral; 2.)
appropriate weigh shift; 3.) dissociation of the limbs from the trunk. Tests of lower
extremity and trunk strength were assessed using hand-held dynamometry and Kendall
methods. Four functional tasks, (single leg eyes-closed balance; topple; airplane and
sauté tests), were assessed along with one IMU-based jump task. Jump height and GRF
were estimated using an inertial sensor (BTS G-Sensor 2, Brooklyn, NY). The sensor,
worn in a pouch on a velcro belt wrapped around the dancer’s trunk at umbilicus
level, contained a triaxial accelerometer, gyroscope and magnetometer and connected
wirelessly via Bluetooth® to a computer. Based on the accelerations measured
by the sensor and the weight of the subject, several parameters were estimated.
RESULTS: Paired t-tests revealed changes from the pretest to posttest assessment
day: hip abduction (p=0.009) and trunk strength (p=0.045), balance (p<0.001),
topple (p=0.006), airplane (p=0.005), all improved significantly; sauté showed a
trend to improve (p=0.084). No G-Sensor jump parameters showed improvement.
CONCLUSIONS: Significant improvements in strength, balance, and alignment were
demonstrated by this cohort. Jump performance did not show improvement, but was
an unfamiliar task to the subjects at the beginning of the training; it will be monitored
intermittently as training continues.
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NewsBot · Oct 16, 2020

Effect of Toe Type on Static Balance in Ballet Dancers
Momoko Kizawa, Toshito Yasuda, Hiroaki Shima, Katsunori Mori, Seiya Tsujinaka, Masashi Neo
Med Probl Perform Art. 2020 Mar;35(1):35-41

Objectives: Some forefoot shapes are ideal for pointe work in ballet. Egyptian-type, with the hallux being longest and the remaining toes decreasing in size, and Greek-type, with the second toe longer than the hallux, are considered less optimal for pointe work. Square-type, with the second toe the same length as the hallux, is considered optimal. This study compared postural stability in the bipedal stance, demi pointe, and en pointe between ballet dancers with the two toe types using a stabilometer.

Methods: This study included 25 Japanese ballet academy dancers who had received ballet lessons for at least 6 years. Toes were categorized into Egyptian-type (n=14) and square-type (n=11). Bipedal stance, demi pointe, and en pointe were tested. Center of pressure (COP) parameters were calculated from ground-reaction forces using two force plates: total trajectory length (LNG), velocities of anterior-posterior (VAP) and medial-lateral directions (VML), and maximum range displacement in the anterior-posterior (MAXAP) and medial-lateral directions (MAXML). Mann-Whitney U-tests were used to examine differences in COP parameters.

Results: There were no differences in parameters during bipedal stance or demi pointe. However, dancers with Egyptian-type toes had significantly greater LNG (p<0.01), VML (p=0.01), MAXML (p<0.01), and MAXAP (p=0.03) during en pointe.

Conclusions: Ballet dancers with Egyptian-type toes demonstrated greater displacement in the medial-lateral and anterior-posterior directions during en pointe. Ballet dancers should be aware of toe types and sway character to optimize ballet training and balance.
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NewsBot · Aug 2, 2021

When Pointe Shoes Come Off: How to Safely Transition Between Different Types of Dance Shoes

NewsBot · Oct 21, 2022

Alignment of the metatarsal heads affects foot inversion/eversion during tiptoe standing on one leg in demi-pointe position: A cross-sectional study on recreational dancers
Akiko Imura et al
PLoS One. 2022 Oct 18;17(10)

Classical ballet dancers stand on tiptoe in the demi-pointe position where the ankle is plantarflexed, and the toes extend around a mediolateral axis passing through the second metatarsal head. Foot sickling, the foot inversion/eversion when the forefoot is grounded, should be avoided to achieve esthetics and prevent injuries during tiptoe standing. The foot inversion/eversion angle may change depending on the metatarsal heads through which the toe extension axis passes. This study investigated the relationship between metatarsal alignment in both load positions and foot inversion/eversion angle during tiptoe standing. Nine recreational female ballet dancers performed tiptoe standing on a single leg in the demi-pointe position. The foot inversion/eversion angle, the centre of pressure (COP) positions, and angles between adjacent metatarsal heads in the horizontal plane were investigated using motion-capture data and magnetic resonance imaging of the forefoot. As the angle between the second and adjacent metatarsal heads became more acute during tiptoe standing on the non-dominant leg, the dancers everted the foot more and significantly loaded the first toe-side more, and vice versa (r = -0.85 and -0.82, respectively). Then, the load positions were distributed on the distal side of the second metatarsal head. These were not seen during standing on the dominant leg with COPs more proximal to the second metatarsal head. In conclusion, dancers load the distal part of the second metatarsal head during tiptoe standing on the non-dominant leg. When the angle at the second metatarsal head was acute, within the triangle formed by the first, second, and third metatarsal heads, even slight mediolateral shifts of load positions altered the toe extension axis around that metatarsal head; the dancers loaded medial to the second metatarsal head and everted the foot and vice versa. Therefore, the angle between the second and adjacent metatarsal heads influenced the foot inversion/eversion angle.
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NewsBot · Nov 19, 2022

Determining Pointe Readiness in Young Adolescent Female Dancers: A Systematic Review
Hough-Coles, Kelly; Wyon, Matthew
Journal of Dance Medicine & Science, Volume 26, Number 4, December 2022, pp. 213-225(13)

Dancing en pointe is an integral aspect of ballet for female dancers and they start pointe training in young adolescence. The primary objective of this review was to investigate the screening tests used to determine pointe readiness in young adolescent female dancers, and the secondary objective was to determine the injuries associated with pointe training. The search engines Google Scholar, PubMed, Scopus, and Web of Science were mined using medical subject heading terms "pointe," "pointe readiness," "injury," "young," "adolescent," "female," and "dancer," and a manual search of relevant articles was conducted. The inclusion criteria were: females aged 8 to 20 years, pre-pointe, training en pointe, and pointe-related injury. The search strategy followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following data were extracted; first author, year of publication, study design, participant size, mean age, testing, outcome, and general notes of each study. Risk of bias was evaluated using the Research Triangle Institute Item Bank (RTI-IB). Eight cross-sectional studies met the inclusion criteria. Results suggested that the topple, airplane, sauté, and relevé tests are statistically better determinants of pointe readiness than chronological age alone. Utilizing these methods alongside age, strength, body maturation, range of motion (ROM), and teacher evaluation could provide an all-round insight into a dancer's readiness for pointe. However, the included studies had contradictory outcomes with regard to pointe-related injury and the review's conclusions are limited by methodological design.
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