Handbook for Young Dancers and Their Families

1. Introduction to Ballet
2. History of Ballet
3. Benefits of Dance
4. Is Ballet Safe
5. What if an injury does occur?
6. When to go On Pointe
7. Nutritional Concerns
8. Shall We Dance?

Introduction to Ballet

Ballet is the epitome of art because it harmoniously blends all art mediums. A ballet production is a combination of stage and costume design, music composition, choreography, and graceful human poses. Ballet training is an athletic activity, and like most sports, provides an enjoyable, challenging and generally safe means of exercise.

Ballet is famous for using movements that display the natural contours and lines of the body. A ballet dancer keeps the body’s line continuous and uninterrupted from the head to the foot, which traditionally is kept pointed when off the ground. When not leaping in the air, a dancer may dance on demi-pointe, meaning on the balls of the foot, or on pointe, with special shoes. Unique to the ballet, pointe shoes are made of satin, burlap, leather and glue and provide enough support to allow the dancer to dance on the tips of her toes, thus lengthening the body’s lines even more. In most classical ballet companies, pointe shoes are only worn by female dancers.

Another characteristic unique to ballet is the idea of "turnout," the external rotation of the leg from the hip so that the dancer’s toes and knees are facing away from the body. All classical steps are executed with the legs turned out. The basic positions of ballet are: first position (with the heels together forming a 180 degree angle), second position (with the feet about a foot apart forming a 180 degree angle), third position (with the heels are crossed), fourth position (with the heel of the front foot lined up with the toes of the foot in the back, while the feet are about a foot apart), and fifth position (with the heels of each foot touching the toes of the opposite foot). The dancer’s arms have corresponding positions as well.

Unlike many athletic activities, ballet permits the dancer to use the entire body, providing a full workout and building tone for all muscles. No special equipment is required for one to dance ballet, other than ballet slippers or pointe shoes. However, a dancer’s uniform, usually consisting of a leotard and tights, is often mandatory, since a ballet dancer is a student of art and is learning a discipline.

History of Ballet

The art of ballet had its origins in 16^th century Italy in the court of Catherine De Medici. When Catherine De Medici went to France to marry Henry II, the Ballet followed her. The first ballets were exclusively court entertainment, and were simple dances strung together to make a grand ballet.

Originally, all dancers were male. Women did not perform in ballets until after 1681. In 1680, the positions of the feet and poses of the body, which are still used today, were codified by Pierre Beauchamps, Louis XIV’s ballet master. Ballet remained a court spectacle until 1708, when the first ballet was commissioned for public performance. Because ballet performances were organized to revive the theater performances of the ancient Greeks, the ballets often told mythological stories. At that time, the dancers were clad in cumbersome costumes and masks. The mask was eliminated in 1773 and the costumes gradually were modified to foster greater movement and flexibility. Dancing "on toe" began to appear in ballets about this time, although the pointe shoe as we know it today had not been invented yet. To permit dancing on toe, dancers strengthened their shoes with darning. In 1820, Carlo Blasis established the turned-out technique, giving ballet one of its trademark characteristics. In the year 1832, the ballet La Sylphide marked the beginning of the romantic period of ballet, which emphasized the weightlessness and ethereal quality that a dancer can have on stage. From this moment in ballet history, women dancers were the main stars of the ballet world.

By the turn of the nineteenth century, the pointe shoe and the short tutu appeared, allowing for even greater movement of the legs than before. Male and female roles in ballet were modified and partnering was established; the female was assigned the more dominant role and the male dancer was assigned the role of supporting the female during the performance. In Paris, in 1909, the Ballets Russe company was formed. The Ballet Russe made Paris the birthing place of such great talents as Michel Fokine (1880-1942), Vaslav Nijinsky (1890-1950), and George Balanchine (1904-1983). Balanchine first started his training at the Imperial Ballet School in St. Petersburg before joining the Ballet Russe in 1924. In 1934 Lincoln Kirstein and Edward Warburg founded the American Ballet company, now called the New York City Ballet, and recruited Balanchine to be the artistic director. Most of Balanchine’s prima ballerina’s were thin, tall and long-legged and his choreography was so unique with its tempos and dynamics that it set a new standard for ballet in the United States. For this reason, he is considered the father of American Ballet.

Since then, the ballet world has been repeatedly remodeled by new choreographers, challenging the traditionally taught techniques with novel kinds of movement. As a result there are different ballet companies that dance in many different styles of ballet. Some companies even perform modern ballet pieces that combine elements of modern dance and classical ballet. The face of ballet is constantly changing and as long as there are eager dancers and choreographers, it always will.

Benefits of Dance

Like any athletic activity, dance offers many health benefits. A pleasant and challenging way to exercise, dance helps maintain bone health and prevents osteoporosis. For older adults, dance preserves cognitive function, can alleviate depression, and provide a sense of self-efficacy. Dance provides low to medium impact exercise that is known to be important in preventing cardiovascular diseases, decreasing the symptoms of arthritis and increasing HDL cholesterol (better known as the "good" cholesterol.) It also decreases diastolic blood pressure, increases lean body mass and can prevent chronic diseases.

In children, dance promotes physical growth and maturation and can aid in the development of motor skills. Although ballet cannot hasten the developmental stages of a growing child, it can help sharpen new motor skills as they appear. Because many of today’s health problems stem from childhood obesity, dance offers additional protection. Active children tend to have a lower body weight and a leaner body mass than their less active counterparts. Starting a training program early can help establish patterns of activity for life. With its many opportunities to participate in public performances, dance can also give a child a sense of accomplishment and confidence. Training also helps build discipline and perseverance, which are necessary for success in any area of life.

Is Ballet Safe?

In general, the injury patterns seen in dancers are not seen in any other athletes, although some activities are associated with analogous injuries. Because a ballet dancer moves at the maximum range of motion of many joints, she or he is at risk for the same types of injuries as ice skaters and gymnasts, although the severity of these injuries is often milder in a ballet dancer. This is due to a variety of reasons. For example, falling holds greater risks for the gymnast than for the ballet dancer, who is not expected to jump as high as the gymnast and is usually not expected to perform on, or off of, an apparatus or prop. Gymnastic exercise pushes the range of motion of joints and muscles even further that what is required for ballet (the back walk-over and the back flip, for example, require more flexibility than the ballet dancers’ port de bras back (leaning back)). Ice-skaters tend to fall more than ballet dancers, and because they have more momentum on the ice, an ice-skater’s falls involve more force upon impact. Ballet dancers also practice in halls and on stages that are usually raised and sprung so that the floor yields as the dancer jumps and lands, decreasing the risk of knee injuries. Ice-skaters do not have this advantage, dancing on ice under which is cement and jumping and landing at higher speeds. Therefore, the study of ballet inherently comes with some protections that other athletic activities do not provide.

The most common ballet injuries are overuse injuries, also known as microtraumatic injuries. These result from the repetitive nature of ballet training. Overuse injuries can occur in the tendon (tendonitis), or in the bone (stress fracture). Tendonitis usually manifests itself as a persistent pain and swelling that worsens after exertion. Stress fractures cause pain at a distinct point along the bone that also worsens upon exertion. Long term consequences of dancing also include osteorthritis.

The risk of injury is greatest at the time of a young dancer’s growth spurt, when the growth of long bones exceeds the rate of growth of soft tissues. This can result in a tightening of the ligaments and a loss of muscle strength. The growth spurt is characterized by bone remodeling, with bone re-absorption exceeding bone deposition. This means that the bones are at their weakest during the growth spurt and the risk of fracture and stress fracture is at its highest.

The period of time associated with the growth spurt is often the most frustrating in a dancer’s training because of the perceived loss of strength and coordination. Luckily, the growth spurt is transient and strength and flexibility return with time. The dancer must be warned to listen to his or her body; and exercise must never be carried out if it is painful. The cliché of "no pain, no gain" is simply not true. Dancers should also be aware of the dangers of practicing with improper technique. For example, rolling-in the feet in any of the turned out positions (i.e., forcing the leg’s turn out from the ground up, by gripping the floor and allowing the arch of the foot to make contact with the floor, instead of initiating the turn out from the hip down) can lead to injury. Forcing the feet to turn out in this manner creates torsion and strain at the knee and eventually leads to knee and hip problems. If the feet are rolled-in, the body will no longer be in proper alignment and the ankle and foot ligaments will be subject to stress. This stress can cause bunions and arch problems if rolling-in is allowed to continue for a long time. To prevent these injuries, students must be patient and should work on turning-out from the hip down.

Injuries can also occur when one muscle group becomes more powerful than the opposing muscle group, creating imbalances that strain the relevant joint. Some knee injuries, for example, can result when the outer thigh muscles become stronger than the inner thigh muscles because of ballet’s emphasis on extension and turn-out. Imbalances such as this can be rehabilitated and even prevented by stretching and strengthening exercises of the tight and weak muscles respectively.

What if an injury does occur?

If a young dancer gets hurt during class or has an identifiable injury that causes swelling but does not result in broken skin, it is important to apply ice to the injury and to elevate the injured area immediately. Ice should not be applied directly onto skin, nor should ice simply be wrapped with plastic and applied to the skin. The ice should be wrapped in a wet towel and applied to the skin for twenty-minute periods. This facilitates recovery by limiting swelling and fluid buildup, thereby reducing damage to the injured area. A pain reliever such as Motrin can be helpful in reducing swelling and easing pain. Thirty-six hours after the initial injury, heat applications can help speed recovery. Heat increases blood flow to the injury, thus increasing the oxygen and nutrient supply available for the healing process.

If a young dancer complains of a persistent pain that won’t go away, it is time to consult a physician. Contact the HSS Sports Medicine Institute for Young Athletes or the HSS Sports Medicine and Shoulder Service for more information.

When to go On Pointe

The issue of choosing the proper time to start wearing pointe shoes has always been a controversial one. Although no formal studies have been done to prove the adverse affects, it is widely believed that wearing pointe shoes too soon can irreversibly damage and deform growing bones in the feet. It is thus important not to start pointe too early, but early enough to allow the dancer to be able to achieve the range of motion necessary for pointe technique while the body is able to adjust.

Therefore, when is the right time in a student’s training to start training on pointe? It is recommended that students should have at least four years of regular ballet training, with classes steadily increasing in difficulty and frequency, before beginning training on pointe. For example, a student who starts ballet at six years old with one class a week should be taking two classes a week by age eight, three by age nine, and so on. The training on demi-pointe will build the strength and flexibility needed for correct pointe technique. The student should be proficient and relatively comfortable executing steps on demi-pointe. This will decrease the likelihood of injuries on pointe resulting from weakness of the ankle and foot and general lack of coordination. Pointe should be started gradually, starting from five minutes of exercises at the end of regular ballet class.

To ensure the least damage to the bones, pointe technique should be started at a time when the bones of the foot are near maturity, which is generally around the age of twelve or thirteen. This issue is complicated by the fact that skeletal age does not always match chronological age. Thus, not all twelve year old girls are ready for pointe, but some ten year olds may be. Each dancer should be dealt with in an individualized manner taking into account the particular stage of development.

Certain times of the year are better suited than others for commencing training on pointe. Growing children tend to gain weight in the fall and grow lengthwise in the spring. Therefore it is advisable to start pointe before the growth spurt, in the months of January and February. The student will be working on strength and flexibility right through their growing months. Parents should be aware that a new pair of pointe shoes might be needed after the growth spurt. Dancers should never wear shoes that are too small for them. It must be noted that not all children follow this seasonal cycling. Teachers and parents should be aware of the dancer’s growth patterns and be supportive of young dancers experiencing the changes in their bodies. Most of all, parents should discourage restrictive dieting behavior that may harm development.

Nutritional Concerns

Proper nutrition is vital to the health of an athlete. Most experts agree that eating all foods in moderation is the key to good health, without using vitamins to replace nutritious foods. Although good nutrition is essential for peak performance, ballet’s aesthetic ideal can lead some dancers to restrict their diet. This adds to the extraordinary pressures a dancer must face. As a result, the occurrence of eating disorders are three times higher in dancers than in the general population.

In the very competitive field of dance, an eating disorder may result from an attempt to control what the dancer perceives as uncontrollable. Warning signs of an eating disorder are: refusal to maintain normal body weight, intense fear of gaining weight, amenorrhea (absence of menses,) disturbed perception of body image, binge eating and purging.

Depriving an active body of nutrients can cause a number of different conditions, some of which can cause permanent damage. In response to a drastic decrease in caloric intake, the body will slow its metabolism and decrease energy expenditure in an attempt to maintain the same weight. This results in fatigue and weakness. If malnutrition continues for a longer period of time, the body will use up its energy stores of fat and eventually begin to break down muscle as a source of fuel. In women, the lack of proper nutrition results in the shut down of hormonal cycles, and thus results in amenorrhea. Estrogen and progesterone have a protective affect on the bones, allowing the body to retain calcium. Without these hormones, the body will reabsorb the calcium from the bones and the bones will get weaker and normal development will not occur. The loss of muscle and bone strength increases the risk of sprains and fractures. A chronic and self-imposed manifestation of these conditions may lead to what is called the female athlete triad: anorexia (lack of caloric intake), amenorrhea, and osteoperosis (loss of bone mass.)

An athlete’s diet should follow the food guide pyramid and include a wide variety of foods. All food groups are crucial and provide athletes with vital nutrients that they need. Of those nutrients, calcium, magnesium, zinc and iron are key players in bone and muscle development. Being especially important to a growing athlete, recommended doses of calcium are between 1200-1500 mg a day. Carbohydrates, the base of the food pyramid, are a primary energy source and they should never be excluded from the diet. They are easily digested and therefore are the meal of choice half an hour to one hour before physical activity. If a dancer is a vegetarian or has other special restrictions on his or her diet, a physician or nutritionist should be consulted to ensure no vital nutrients are absent. Diets of dancers should never be restricted to the point where the health, strength and well-being of the dancer are sacrificed.

Shall We Dance?

Ballet provides an exciting way of life for those who choose to make it their career. A dancer is more than just an athlete, but a visual artist and technician as well. All people can participate in this artistry by taking ballet classes regularly, simultaneously enjoying the benefits of a wonderful and enjoyable form of exercise. For children, it provides an outlet for creative talents and is a medium through which to gain confidence and poise. For a growing adolescent, the study of ballet and participation in performances offer new and captivating experiences and a feeling of accomplishment. For adults, ballet keeps energy levels high and helps maintain a healthy lifestyle. For professionals, it is a chance to shine and inspire others. Whatever one’s age or circumstance, the benefits of ballet are enormous.

Shall we dance? Definitely.