Shoulder pain and cortisone injections


The commencement of dancing en pointé is a milestone for every young classical Ballet dancer. And while the professionals may make it seem that this is an easy thing to do, there are specific anatomical and biomechanical requirements to make the recipe of getting your foot up over the block achievable. 

As a trained dancer and dance physiotherapist I both personally and professionally have an understanding of the specificities of the foot required to make the transition to pointé work both enjoyable and safe for a flourishing experience.

Here’s what’s involved in commencing pointe work and the important steps dancers and teachers take to make sure the dancer is physically ready for this beautiful but demanding art form.

1. Physical Readiness and Strength

Before a dancer is considered ready for pointe work, their body must meet several physical prerequisites. Pointe work places significant stress on the feet, ankles, and legs, so it’s crucial that the dancer’s body is strong enough to handle the demands without risk of injury.

  • Core Strength: A dancer’s core muscles (abdominals, back, and pelvic floor) provide the stability needed to maintain balance and control while on pointe. Without a strong core, it’s difficult to stay aligned and safe during pointe work.
  • Ankle and Foot Strength: Dancers must have fully developed strength in the muscles of their feet and ankles to support the additional stress that pointe work places on them. This strength is built through years of training in demi-pointe (on the balls of the feet), and exercises such as rises, relevés, and theraband work are essential in developing the necessary support.
  • Leg Alignment and Turnout: Proper leg alignment and turnout are essential for both safety and aesthetics in pointe work. If a dancer’s turnout is forced or their alignment is poor, it can put undue strain on the knees, hips, and ankles, making pointe work dangerous. Teachers will closely assess a dancer’s turnout and alignment to ensure they are ready.

2. Age and Maturity

Dancers generally begin pointe work between the ages of 11 and 13, although this can vary depending on the individual. While age can serve as a general guideline, it is the dancer’s physical development and maturity that truly matter.

  • Bone Development: A key factor in determining readiness for pointe is whether a dancer’s bones, particularly in the feet and ankles, have matured enough. Starting pointe too early, when the bones are still soft and developing, can lead to long-term injuries and deformities. Most dance teachers and physiotherapists recommend waiting until the dancer’s feet are fully formed to minimize these risks.
  • Emotional Maturity: Pointe work is challenging and requires discipline, patience, and the ability to take correction. Dancers need to be mature enough to understand the demands of pointe and follow instructions carefully to avoid injury.

3. Pre-Pointe Assessments

Most dance schools and studios now require dancers to undergo a pre-pointe assessment conducted by either a ballet teacher or a physiotherapist with experience in dance. The purpose of this assessment is to evaluate whether a dancer has the necessary strength, flexibility, and technique to safely begin pointe work.

  • Posture and Alignment Check: The assessment will look at the dancer’s posture, making sure they have the ability to maintain correct alignment while dancing. This includes checking their balance, turnout, and pelvis stability.
  • Ankle Flexibility and Strength: Assessing the range of motion in the ankle joint is critical. The dancer needs to have enough plantarflexion (the ability to point the foot downward) to rise onto pointe safely. At the same time, the dancer’s ankle strength is tested through movements like single-leg relevés and rises, ensuring the ankle is stable enough to support the full weight of the body on pointe.
  • Core and Lower Limb Strength: Physiotherapists will evaluate the strength of the dancer’s core, hip, and leg muscles to ensure they can stabilize and control their movements while on pointe. Weakness in these areas can lead to poor alignment and an increased risk of injury.

The result of the pre-pointe assessment helps determine whether a dancer is ready to begin pointe or if they need further strengthening before taking that step.

4. Fitting the Pointe Shoes

Once a dancer is deemed physically ready to begin pointe work, the next crucial step is finding the right pair of pointe shoes. Pointe shoes are highly specialized and must be fitted perfectly to the individual’s foot structure to provide the necessary support and protection.

  • Toe Shape and Length: Pointe shoes come in different shapes to accommodate various foot types, including tapered, square, or slightly rounded toes. A professional pointe shoe fitter will assess the dancer’s foot shape and recommend the appropriate shoe.
  • Shoe Hardness: The shank (the supportive part of the sole) and the box (the hard toe part) come in varying degrees of hardness. A dancer who is just starting pointe work may benefit from a shoe with a more flexible shank to allow for proper foot articulation while still offering support.
  • Padding and Ribbons: Proper padding, such as toe spacers or gels, can help reduce pressure on the toes, while ribbons and elastics are sewn onto the shoe to secure it tightly to the foot.

5. Initial Training on Pointe

Starting pointe work is a slow and gradual process. Dancers begin with simple exercises at the barre, allowing them to focus on strength, alignment, and technique while receiving support. Here’s how the initial training unfolds:

  • Barre Exercises: Exercises like relevéséchappés, and piqués at the barre help dancers learn to rise onto pointe with control and proper technique. Barre work allows the dancer to build strength and confidence without the added challenge of balancing in the center.
  • Focus on Technique: Proper technique is critical to avoid injury, so teachers will emphasize maintaining correct alignment, posture, and turnout while on pointe. Dancers learn to engage their core, lift through their legs, and avoid “sitting” in their pointe shoes.
  • Building Strength Gradually: Dancers typically start with just a few minutes of pointe work at the end of their regular ballet classes, gradually increasing the time and complexity of exercises as they build strength and control.

6. Ongoing Strengthening and Care

Pointe work requires constant care of the feet and ongoing strengthening exercises. Dancers are encouraged to continue their foot and ankle strengthening exercises even after they begin pointe work. Regular stretching and massages are also important for maintaining flexibility and preventing injury.

Physiotherapists often recommend cross-training, such as Pilates or strength training, to build muscle endurance and protect the dancer’s body from overuse injuries, especially as the demands of pointe work increase.

Conclusion

Commencing pointe work is an exciting achievement for any ballet dancer, but it is a process that requires patience, dedication, and careful preparation. Ensuring a dancer is physically and mentally ready through proper assessments, strength training, and gradual progression helps them transition to pointe safely and confidently. While pointe work may be challenging, the reward is a dancer’s ability to perform the elegant, ethereal movements that make ballet so magical.

Physiotherapist (BPhyt) & Pilates Practitioner