Grace Under Strain: The Undeniable Toll of Ballet Injuries

Ballet is predominantly regarded as an artistic form, yet its emphasis on achievement and excessive training inevitably positions it within the realm of sport. The dedication and commitment demanded by ballet are on par with those of elite individual or team sports. However, the somber reality of ballet is that it likely holds the unfortunate distinction of having the highest incidence of injuries, surpassing all other sports by a considerable margin.

Research indicates that the average professional dancer experiences a staggering 47-97% occurrence of injuries annually, with a substantial 62% of these injuries afflicting the feet and ankles. Among these, ankle sprains emerge as the most prevalent and responsible for significant disruptions to training. Major contributors to these injuries are the result of overuse, persistent repetition, micro-trauma, and insufficient recovery, collectively accounting for 65.9% of chronic and recurring injuries.

Regrettably, the most distressing aspect of ballet lies not only in the pain endured during participation but also in the enduring consequences it inflicts upon the body. A notable ballet physiotherapist recently asserted that all her former leading dancers have either already undergone hip replacements or are destined to undergo them in the future.

The cause of chronic ballet injuries

There are many factors that contribute to chronic injuries in ballet. They include the following:

  • Workload – excessively long hours of training
  • Lack of fitness –injuries happen easier if the dancer is tired
  • Body alignment – a misaligned body will be injured by the slightest overload
  • Joint integrity – the joints of pre-puberty dancers are not yet fully matured and cannot handle stress
  • Previous injuries – cause lack of strength and balance issues
  • Lack of nutrition and eating disorders cause diminished musculoskeletal health
  • Flooring – hard floors increase the impact on the body
  • Bad technique – can be due to improper training.
  • No seasonal breaks
  • Psychological and emotional pressures
  • Fear to lose contracts if reporting injured
  • Fear that therapist may suggest taking time off, thus refusing therapy
  • A fear of recurring injury leads to compensation patterns, imbalance and adds to emotional vulnerability

The ballet technique

There are 5 classical foot positions in ballet which all require the dancer to externally rotate the hip and ankle way beyond maximum:

Notice that all 5 these positions require 90° of external rotation of the hip and ankle.

The effect on the hip:

In a standard standing position, the normal range of external hip rotation is around 45°. This implies that as a ballet dancer, you’re expected to amplify that range twofold, which effectively pushes the hip way beyond its natural mobility limits. Even if a dancer manages to achieve the complete range as required, it’s not solely a matter of straining the hip joint; it also leads to a shortening of the external hip rotators (Gluteus Maximus and Biceps Femoris) and an excessive elongation of the internal rotators (TFL, Gluteus Medius, and Minimus) as the majority of hip movements in ballet are performed with the hip in the abnormal range of external rotation.

This imbalance and misalignment not only impact the hip joint but also extends to the lower back. Consequently, it’s hardly surprising that a significant number of professional dancers eventually struggle with persistent back pain and, in some cases, necessitate hip replacements.

The effect on the ankle:

Although most dancers are unlikely to achieve a 90° external hip rotation, the only viable solution seems to be coercing the ankle joint to compensate for this limitation. It’s important to note that the ankle possesses a functional range of merely 10° towards external rotation. To surpass this constraint, all relevant joints must be forcefully subjected to reach the required position. Unfortunately, this results in an undue shortening of the outer ankle and foot structures, coupled with an excessive lengthening of the inner components.

To add to these challenges, ballet demands extreme plantarflexion when in the point position. This, along with the abnormal strain placed on the joints of the big toe, this inevitably sets the stage for chronic foot and ankle injuries as well as deformities. It’s rare for ballet dancers to avoid developing bunions and toe deformities, and these conditions tend to worsen as they age.

Why has ballet never adapted like other sports?

When we look at other pro sports, you can see a clear pattern where they’ve updated rules and gear to keep athletes safe. They’ve adjusted techniques and training methods to prevent injuries and keep players healthy. But unfortunately, ballet doesn’t seem to be on the same page.

Ballet, on the other hand, hasn’t really changed much over the years. Dancers still wear the same kind of shoes, and their training methods have stayed pretty much the same. While ballet teachers might try to make things safer, choreographers keep pushing for riskier and more daring moves from the dancers. This creates a situation where dancers willingly take big risks, even with their health, just to keep up.

Maybe it’s time for ballet fans and supporters to start focusing more on the well-being of the dancers. We should recognize the real challenges they face instead of just thinking of ballet as an art form and ignoring the tough reality underneath it all.

How does Lyno approach chronic injuries?

 At the start of each Lyno session, we conduct a thorough evaluation of fascia mobility. We know that any limitations within the fascia or connective tissues can trigger imbalances and place excessive strain on other musculoskeletal structures.

Fascia limitations typically arise as a consequence of repetitive trauma and overloading. The key to preventing the recurrence of these restrictions lies in guiding clients away from the habits that contribute to them. In most other sports, our focus would then shift towards refining technique and cultivating strength to maintain a  well-functioning body.

However, ballet and female gymnastics present unique challenges. The very nature of these sports instigates the overload and damage that we aim to counteract. Instead of transitioning to more functional movement patterns, ballet continuously intensifies efforts in the opposite direction, consistently pushing the body towards heightened overload and dysfunction.

As Lyno practitioners, we find ourselves in a difficult position, battling against these sport-specific demands. In the end, our capacity primarily extends to ongoing maintenance, without the prospect of transformative outcomes.

Our approach places a premium on holistic well-being, encompassing not only the physical but also the emotional dimensions. These two facets are interdependent, where our emotions profoundly influence our movement patterns, and any physical dysfunction reverberates in our emotional state.

Reading about the persistent fear of injury and the anxiety of underperformance, coupled with the relentless cycle of repetitive strain within dysfunctional movement patterns, raises an alarm. 

In the reality of professional ballet, an approach based on holistic wellness seems to be out of place. The fortunate few emerge as stars, while the majority struggle with chronic injuries and a profound sense of loss. Even the star performers aren’t immune to lasting bodily damage.
Nevertheless, should a dancer opt to step away from the demands of ballet and embark on a journey towards comprehensive recovery, Lyno stands ready and willing to support and guide them through this transformative process.