When Is It Safe for a Ballerina to Begin En Pointe Training?

Many young ballet dancers dream of one day performing on stage. One of the essential elements of becoming an accomplished ballerina is that of being en pointe. Not every ballet dancer reaches the level of dancing en pointe, but many do. Questions regarding "When is pointe work safe?" and "What needs to be considered before beginning pointe work?" are commonly asked.

In general, ballet dancers should not begin pointe work until around the age of 12. Age alone is not the only determining factor as many other markers need to be met. There is a level of physiological maturity that needs to occur. Development can vary. In general, a young dancer who is in a pre-professional track with a ballet school will be groomed from the age of 8 or 9. There is a specific curriculum addressing flexibility and strength with appropriate progression. Proper technique instruction involving placement and pelvic alignment is taught in these classes. Usually, after 4 years of specific training and the addition of ballet classes to 3-4X/week, a young dancer will meet the criteria to begin rising onto her toes more safely. According to Ms. Abbie Siegel, Principal of Pacific Northwest Ballet School, PNB teaches technique according to their syllabus in a very specific manner. Instruction on the appropriate way to go up on pointe and come down from pointe, as well as how to use the muscles and how the dancer should feel when en pointe are all components of the education. Once the ballerina achieves the success of getting up en pointe, further consideration is given to the ability to maintain turn out while on pointe. "Every step of the way the dancers are being monitored and assessed," states Ms. Siegel. There is a difference between a young dancer in a pre-professional curriculum who has developed the necessary strength, flexibility and proprioception and another ballet dancer that starts taking classes at 8 years old, but by the age of 12, is taking ballet more infrequently and who has not mastered the same criteria. The dancer taking ballet more infrequently and combining with other forms of dance is enjoying classes, but is not in a specific track which has cultivated the necessary components to safely proceed onto pointe. The distinction between the two types of dancers is further explained by Dr. David Weiss et al, 2009 in the article "When Can I start Pointe Work," referenced below.

Secondly, strength is critical. Core, hip and ankle stability are all necessary for success. The dancer needs to be able to control their mechanics proximally through the lower abdominals, spinal stabilization muscles and gluteal muscles of the hip to successfully control the demands of en pointe. At PNB, a very specific pre-pointe curriculum addressing conditioning of the feet, ankles, hips and torso (core) must be mastered before progressing into pointe classes. Often young dancers are very flexible and grow at a significant rate where neuromuscular control is not adequate. Hyperextension (arching) in the dancer's low back is often seen, which can be problematic if not controlled by their core strength. Avoiding an anterior pelvic tilt and hip hiking is also important to proper technique and mechanics. Ankle strength involving all 4 major muscle groups surrounding the ankle along with proprioception and balance training are also critical to the success of en pointe. The dancer should be able to maintain weight on their toes without sickling (turning inward) or winging (turning outward) through their foot while in demi pointe (on ball of foot) or pointe (on toes). The ability to be able to perform approximately 25-30 single leg calf raises consecutively from flat to demi-pointe, while maintaining technique and balance, is also a good marker. There is a series of releves that is in the syllabus at PNB along with other strengthening work for pointe preparation that begins in the level 1 classes for the young dancer. The dancer does not begin pointe work until reaching level 4 class in this curriculum.

Another important factor is range of motion which is determined by joint mobility and flexibility. Dancer's need to have an appropriate amount of turn out (external rotation) from their hips and lower extremity exceeding normal values. They also need to be able to maintain that turn out when transitioning from a flat foot position in stance to either a demi-pointe or full pointe position. Foot mobility and structure is also extremely important. Being able to achieve 90-95 deg. of ankle plantar flexion of pointing the foot downward with a good shape is necessary to be able to maintain en pointe in stance. Adequate mobility needs to be present in the metatatarsals. If there is not an adequate instep or arch, the dancer will not be able to get up over the toe box in the pointe shoe and should not be allowed to go en pointe according to Ms. Siegel. If the dancer is unable to keep the knees straight while on their toes, more time may be needed for strengthening.

With respect to the decision of a dancer beginning pointe, Dr. Steven J. Anderson with Orthopedic Physician Associates in Seattle and lead consulting MD for Pacific Northwest Ballet, considers many variables related to the "participant" and the "program." Some of the considerations for the participant include: "Does the participant plan to dance in ballet professionally?" "Do they have any injuries or physical conditions that would prohibit doing pointe work or would lead to further injury if they attempted to do pointe?" He also takes into consideration frequency of ballet classes, years in training and adequate access to a medical specialist as needed for further assessment and treatment. In respect to the program, he states "The program should have a good answer to the question of 'how do you determine when a dancer is ready to start pointe work?' and 'what is your schedule for training and bringing the dancers along at an appropriate pace?'" He also comments to the need for the program to be able to discuss criteria for determining when it is not appropriate to have a dancer start or continue in pointe training. Dr. Anderson reports, "it should be a program that has experience training dancers en pointe and trains dancers to dance in professional ballet companies." He believes parents of young dancers should be looking for "program" elements like the ones discussed previously in the PNB curriculum when considering pointe training. He also comments on the need for "the program to be able to make a recommendation for a pointe shoe provider and fitter who works with beginners." Finally, Dr. Anderson states, "an assessment of mobility, flexibility, strength and proprioception by a physical therapist can be a valuable part of a pre-pointe evaluation."

In conclusion, many variables such as level of expertise in ballet school instruction, years of study and frequency of ballet classes, physiological structure and flexibility, technique as well as strength must all be considered in transitioning a ballerina to en pointe training. When a dancer has done the necessary work in an accomplished dance school, success and artistic beauty can be attained in mastering pointe!

AUTHOR:

Anne Harmon Grout, PT, MSPT, BSHSE

CONTRIBUTORS:

Abbie Siegel
Principal of PNB school
Dr. Steven J Anderson
Sports Medicine Physician
Dr. Camille Clinton, MD
Orthopedic Surgeon
Dr. Christopher Boone, MD
Orthopedic Surgeon
Ben Wobker, PT, MSPT, CSCS, CFSC, SFMA

REFERENCES:

Weiss D., Rist R A. and Grossman G. When Can I Start Pointe Work? Guidelines for Initiating Pointe Training. Journal of Dance Medicine & Science. 2009;13(3):90-92.