• Dr. Jennifer Nicole Falk

Are Radiographs Necessary Before Going On Pointe?

Updated: Aug 13, 2018



When a ballet dancer is ready to trade in her ballet slippers for pointe shoes, a pre-pointe evaluation is performed in order to determine her readiness to start pointe work. And, although the elements included in the pre-pointe evaluation may vary from one company to the next, the dancer’s age appears to be the most consistently used component. Because dancers mature at different rates, though, both physically and mentally, there is still controversy regarding the age a dancer must be prior to dancing on pointe.

Age & Starting Pointe Work


​​According to multiple studies, pointe work tends to begin around 11-12 years of age (1,3,4). While some believe this age is based solely on tradition,others associate 12 years old to having around 4 years of training and experience, which means the dancer has also likely developed the strength and technique for pointe work by this time (1,2,4,6). The fear of starting pointe work too young, though, has to do with bone immaturity and the potential for fractures or growth plate arrest.

Growth plates are regions of cartilage at the ends long bones. The cartilage is weaker than the surrounding bone and less resilient to excessive forces placed on the body, so, while open, these regions remain at increased risk for injury (1,4). Furthermore, while dancing on pointe, when forces increase up to twelve times one’s body weight, there is amplified potential for fractures to occur (1). The excessive microtrauma placed on the foot joints can also cause a stop along thegrowth plates and ultimate shortening of the affected limb, which has been documented in the upper extremities of young gymnasts (1,4).

The Role of Radiographs

Some dance companies send their dancers to a physician for x-rays before starting pointe work to evaluate for closure of the growth plates in their feet. Unfortunately, even if the growth plates are shown to be closed on x-rays, there is continued ossification for years afterwards and complete bony maturation does not typically occur until 18-20 years of age. Therefore, if a dancer were to wait until this point, she would potentially lose her chance at a professional ballet career (1,4).

Are X-Rays Necessary Before Starting Pointe Work?

In 2004, Meck et al analyzed 74 instructors’ pre-pointe evaluations. Despite having more than 75% of the institutions report using an 8-point evaluation, only 9.5% of all institutions reported using radiographs as one of their components. A number of physicians have also remarked that routine radiographs are unnecessary for clearing a dancer to go on pointe (1,2,4). In their article, Drs. Lai and Kruse stated that experience and strength are better indicators than age alone for knowing when to transition a dancer onto pointe (1). And, with only one reported case of growth plate arrest in a teenage ballet dancer as a result of dancing on pointe (to my knowledge) (5), there is a valid argument for not taking routine radiographs.

Making the Decision: Risk vs Benefit

Like other components of the pre-evaluation process, input regarding taking radiographs before starting pointe work should not only come from the instructor, but also from the dancer, her parents, and the healthcare professional involved, in order to help minimize the risk of injury to the dancer. Knowing that repeated radiographs will cause increased radiation, closure of the growth plates doesn’t mean complete bony maturation, and the dancer will may start pointe work regardless of the result, only means that the x-rays were irrelevant. This does not mean that they should never be utilized. If a dancer has a foot abnormality or a history of an injury that may prevent, or delay, her from going on pointe, an x-ray may be helpful in the decision-making process.

Deciding whether or not to take x-rays before starting pointe work should be done on a case-by-case basis, but in my opinion, I agree with prior reports in that routine x-rays, simply to check for growth plate closure, is unnecessary.

DISCLAIMER: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have questions or concerns related to your health.

References:

  1. Lai, J. C., & Kruse, D. W. (2016). Assessing Readiness for En Pointe in Young Ballet Dancers. Pediatric annals, 45(1), e21-e25.

  2. Lin, V. K. (2011). When to go En Pointe. Springfield: Rehabilitation Medicine Associates (RMA).

  3. Meck, C., Hess, R. A., Helldobler, R., & Roh, J. (2004). Pre-pointe evaluation components used by dance schools. Journal of Dance Medicine & Science,8(2), 37-42.

  4. Shah, S. (2009). Determining a young dancer's readiness for dancing on pointe. Current sports medicine reports, 8(6), 295-299.

  5. Shah, S. (2017). Premature growth plate closure in a ballet dancer en pointe. Clinical Journal of Sport Medicine, 27(5), e69-e71.

  6. Weiss, D. S., Rist, R. A., & Grossman, G. (2009). When can I start pointe work? Guidelines for initiating pointe training. Journal of Dance Medicine & Science, 13(3), 90-92.

#ballet #balletdancer #ballerina #onpointe #enpointe #pointework #balletinjuries #dancer

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