Assessing Ballet Pointe Readiness in Young Dancers

Lynn Batalden, physical therapist, physical therapy, dekalb, IL
Lynn Batalden, DPT, OCS

Background: Most young ballet dancers eagerly await the time when they will get to advance to dancing en pointe; and if they wish to dance ballet professionally, dancing en pointe is a requirement.  The purpose of this article is to summarize the research related to determining a dancer’s ability to successfully transition from ballet slippers to point shoes.

Methods: A literature review was performed via APTA’s ArticleSearch with the following key words: Ballet Pointe Readiness. Six relevant articles were found in the search. A search from APTA’s link to Cochrane reviews with key words of Ballet Pointe Readiness yielded no relevant results.  A search of PubMed was conducted with key words of Ballet Pointe Readiness. 

Results:  The APTA’s ArticleSearch resulted in 7 articles, six of which were relevant to the topic. Three of the studies were correlational analyses.  One was a narrative review and one was a literature review.  One was not able to be obtained.  The PubMed review yielded 7 articles, three duplicating the APTA search, one literature review, and one narrative review. Two studies were not obtained.

Conclusions:  Biomechanical demands on the body of the dancer are intense. Dancing in regular ballet slippers increases the forces placed on the foot by four times body weight, while dancing in pointe shoes increases these forces by 12 times body weight (3).  The lower extremity is the most common injury site for dancers (1, 8), and according to a literature review by Russell, 84-95% of dancers are affected by injury across their careers. (8)

Determination in the past of when to advance to pointe has largely focused the chronological age of 12 years due in large part to concerns about the growth plates. (1,2) Evidence is cited in Shah’s article(1) that although gymnasts incur injury related to skeletal immaturity at the wrist, dancers have not been shown to suffer the same,  and no growth plate arrest has been reported in the literature for dancers. Further, growth plates in the foot and ankle do not close until 18-20 years of age, and advancing to pointe after that age would mean no career in ballet. (1) These points leave no justification to use x-ray to determine growth plate status.

In a survey of 74 American dance schools, eight components were commonly used: age, years of dance experience, present and past injuries, relevé alignment and stability, plié alignment and stability, tendu strength and activation of the intrinsic foot muscles. (7) Having a given amount of dance training does not correlate with readiness for pointe. (5) Three of the studies searched set out to research what functional tests, strength tests, and technical skills could be used to assess motor control that may be useful in this determination.  (1, 5, 6) Richardson’s study tested pre-pointe students, and DeWolf and Hewitt’s study compared pre-pointe to en pointe students. Richardson’s study positively correlated three tests with dance teacher’s ratings of readiness for pointe work.  These tests were the “Airplane” test, the “Topple” test, and the”Sauté” test.  Hewitt’s study found the same 3 tests to be a good discriminator between pre-pointe and en pointe students, and did not find the plank test or the heel rise test to be significant for discriminating between groups, but did note that these tests could be used for teaching and diagnostic purposes.  DeWolf emphasizes that the quality of motor control during the airplane test is more important than the number of repetitions and video samples may be helpful for better analysis.  DeWolf’s study found the tests that were categorized as testing muscular capacity and balance showed statistical significance to distinguish between pre-pointe and en pointe dancers,  contributing 15 continuous single leg relevé and two repetitions of the Airplane test may be the best cut-offs for a pre-pointe screening protocol.  Tests that were categorized as ROM in this study did not reach statistical difference between the two groups. All three studies have relatively small sample sizes and it should be noted that correlational studies cannot prove cause and effect, but are useful as a pointer for further, more detailed research. Reliability and validity of these tests is yet to be established. (5)  Altman’s article stresses that despite the importance of injury prevention, there is no formal research to validate pre-pointe training or whether participating in such a program would reduce injury risk for en pointe work, and there is no research on the best way to transition a student. The dance teacher’s assessment of the student’s technique is an important part of assessing readiness as fitness and core strength is not enough to succeed (6), though DeWolf proposes these opinions would benefit from being more standardized.

 All studies cited in this review list ankle plantarflexion as a key component of pointe readiness.  Standard ranges of motion expected in young dancers are approximately 88 to 90 degrees of non-weight bearing plantarflexion, 10-15 degrees of non-weight bearing dorsiflexion, and 30-40 degrees of weight bearing dorsiflexion measured with an inclinometer. (5) The foot and ankle complex at 90 degrees of plantarflexion allows the subtalar joint to lock for stability, and less than this poses risk for ankle inversion injury. (1) And most importantly,  all studies emphasize that dancers need a comprehensive approach to the determination of pointe readiness including understanding of the changes that occur during puberty, psychosocial factors, maturity, and readiness for the rigors of training.

Lynn Batalden, PT, DPT, OCS, CAPP, RYT

Single Leg Sauté Test (5)

The single leg sauté test evaluates dynamic trunk control and lower extremity alignment. The dancers began in coupé derriere with the gesturing leg and standing leg turned out as if they had just completed a jeté ordinaire. Hands were placed on the hips. The participants then jumped into the air and had to demonstrate the following:

1. A neutral pelvis;

2. An upright and stable trunk;

3. A straight standing leg in the air;

4. A pointed standing foot in the air;

5. No movement in the leg maintaining the coupé; and

6. A controlled landing in plié, rolling toe-ball-heel through the foot.

 Participants attempted up to 16 sautés on each leg. The test was video recorded and replayed in slow motion for analysis. Each jump that met technical criteria was counted toward the total score. Right and left sides were then added together for the total score.

Topple Test (5)

The topple test assesses the dancer’s ability to perform a clean single pirouette. For the pirouette to be considered “clean” the dancer must demonstrate the following properties:

1. Proper beginning placement (square hips, the majority of weight on the forefoot, turned

out, pelvis centered, and strong arms;

2. Leg brought up to passé in one count; 3. Supporting leg straightened; 4. Torso turned in one piece; 5. Strong, properly placed arms; 6. A quick spot; and 7. A controlled landing.

The dancers were allowed three attempts on each leg. One point was given for each technical criterion that was met, and the best pirouette on each leg was scored. Right and left scores were combined for the total score. The test was recorded using a Samsung Galaxy S5 video camera (Ridgefield Park, NJ). Videos were replayed in slow motion to enhance precision of analysis.

Heel Rise Test (5)

A heel rise test determines endurance of the calf musculature. The dancers stand on one leg with the contralateral leg held in a parallel coupé. They performed as many relevés without plié as possible to a set beat of 120 beats per minute, or 30 heel raises per minute. The test ended when the dancer could no longer keep time with the metronome or chose to stop. For practical considerations, if a dancer performed 75 relevés the test was stopped. Both left and right legs were tested and the number of relevés for both legs were added together for the total score.

Airplane Test (8,5,1)

The dancer stands on one leg while bending over at the waist and extending the other leg backward such that it and the trunk are parallel to the floor. In this position, then, the dancer is facing downward at the floor. The upper extremities are extended outward from the shoulders, also parallel to the floor. The dancer then lowers herself by flexing the knee of the support leg, simultaneously keeping the trunk and non-support leg parallel to the floor and bringing the fingertips of both hands downward, while maintaining extended elbows, to touch the floor in front of the face. The dancer then extends the knee and upper extremities to return to the starting position. Four out of five consecutive trials performed are required to pass the test in Richardson’s study and 2 high quality repetitions in DeWolf’s study. An unsuccessful attempt is defined by pelvic drop, hip adduction, hip internal rotation, knee valgus, or foot pronation during the movement. DeWolf details a point scoring system for various aspects of motor control that he suggests should be further researched.

References:

  1. Richardson, M; Liederbach, M; Sandow, E; Functional Criteria for Assessing Pointe-Readiness. Journal of Dance Medicine & Science, 2010; 14(3): 82-88.
  2. Shah, Selina. Determining a Young Dancer’s Readiness for Dancing on Pointe. Curr.Sports Med. Rep., 2009; 8(6): 295-299.
  3. Meck C; Hess R; Helldobler R, et al. Pre-pointe evaluation components used by dance schools. J. Dance Med. Sci. 2004; 8:37Y42.
  4. Hamilton WG. Ballet. In: Reider B, editor. Sports Medicine, The School-Age Athlete, Philadelphia: W.B. Saunders Company; 1996.
  5.  DeWolf, Andrew; McPherson, Alyssa; Besong, Kathryn; Hiller, Claire; Docherty, Carrie; Qualitative Measures Utilized in Determining Pointe Readiness in Young Ballet Dancers. Journal of Dance Medicine & Science, 2018; 22(4): 209-217.
  6. Hewitt, Shayla; Mangum, Michael; Tyo, Brian; Nicks, Clayton; Fitness Testing to Determine Pointe Readiness in Ballet Dancers. Journal of Dance Medicine & Science, 2016; 20(4): 162-167.
  7. Altmann, C; Roberts, J; Scharfbillig, R; Jones, 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?; Journal of Dance Medicine & Science, 2019; 23(1): 40-45.
  8. Russell, J; Preventing Dance Injuries: Current Perspectives Open Access Journal of Sports Medicine 2013:4 199–210.
  9. Lai J, Kruse DW. Assessing readiness for en pointe in young ballet dancers. Ped Anals. 2016;45(1):e21-e25
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