INJURIES IN CLASSICAL BALLET

Injuries IN CLASSICAL BALLET

Adriana Coutinho de Azevedo Guimarães * Joseane Paulini Neves Simas **
SUMMARY
This study aimed to elucidate the possible injuries that can occur depending on
the practice of classical ballet. The study was literature, with bibliographies
and foreign. The literature review indicated that the technical and aesthetic ch
aracteristics lead to a practice with no anatomical movements, leading to classi
cal dancer with a group of associated injuries, most injuries are due to errors
and technical training, problems in children are due to attempts to force the ex
ternal rotation at the hips and misuse of the pointe shoe, the most common injur
ies are foot and ankle, followed by knee and hip, and those that happen are the
least of the upper limb. These injuries occur due to excessive exercise and repe
titions, always using the same hand, and misuse and early pointe shoe. It is con
cluded that the technique of ballet, when misapplied, predisposes its practition
ers to characteristic lesions.
Keywords: dance, ballet, injuries.
INTRODUCTION
In its elemental form, dance is a natural and instinctive man exhausted by the d
rive, its latent state. The classic ballet is the development and transformation
of primitive dance to a dance formed by different steps, links, gestures and fi
gures previously developed (DI DONATO, 1994). Historically, classical ballet was
born with the Renaissance in the sixteenth century, the Medici Court in Paris,
initially reflecting gestures, movements and patterns typical of the time (BAMBI
RRA, 1993). Since then, Malanga (1985) highlights that the evolution of classica
l technique was guided by the quest for lightness and agility in which the dance
r seeks total mastery of the body, their muscles and their movements, so you can
use it so expressive without being tied to natural limitations. The author emph
asizes that the classical technique has certain principles of
*
posture - an upright, elongated - and placing the body, which must be kept in ev
ery movement, bringing the full potential of balance, agility and harmonic motio
n of the human body, and hence its value and permanence in time. Moreover, Bambi
rra (1993) cites that the ballet can not be seen only under an ethereal vision,
he is a complex whole in which the principal is the artist's talent and mastery
of technique. Complementing, Lima (1995) points out that classical ballet is the
involvement in the artistic world through a highly technical and complex practi
ce, which requires of its practitioner performance athlete. Among the studies th
at emphasize the risks caused by physical activity the body, found Watson (1983)
, Juli (1983), Gonçalves et al. (1989) and Mota and Maia (1992), which stressed
that the structures of the body are affected by the shape of
Professor of Rhythmic and Dance at the University of Santa Catarina (UDESC / CEF
ID), Master in Physical Education from Universidade Federal de Santa Catarina /
CDS. Collaborative teacher at the University of Santa Catarina (UDESC / CEFID),
post-graduate degree in Physical Rehabilitation and Prevention.
**
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90
Guimaraes and Simas
implementation, the amount and specificity of the movement. Juli (1983) adds tha
t when physical activity is carried to certain limitations, requiring the most m
uscles and tendons, bones and joints can act as a pathological agent on the loco
motor system. In this sense, Schafle (1996) mentions that the high range of moti
on of hip and knee, and the repeatability of these movements may be unbalanced m
uscle groups, thus altering the biomechanics of the body and compromising the fu
nction, increasing the body structure, which may increase the susceptibility the
characteristic lesions in ballet dancers. This review study aims to elucidate t
he possible injuries that can occur depending on the practice of classical balle
t, but also characterize the technique and practice of classical ballet.
CLASSICAL BALLET
TECHNIQUE OF CLASSICAL BALLET
The dance was born with humanity itself and, second Bambirra (1993), the oldest
documents prepared by the men, found in caves, show dance steps, whether in pain
tings or drawings carved on the stone itself. The classic ballet is the developm
ent and transformation of primitive dance, which was based on instinct, to a dan
ce formed by different steps, links, gestures and figures previously developed f
or one or more participants (DI DONATO, 1994). To Malanga (1985), classical ball
et works essentially the amplitude of joint movements,€the accuracy of their tur
ns on or off the body axis and the field of emotional balance, generates confide
nce and overcomes the limitations of body, and enhances the personality, leads t
o self-esteem and self-esteem, which consequently leads to the mastery of techni
que . The practice of classical ballet can develop and enrich the qualities of m
an and in this context Achcar (1998) says that the physical beauty, vision, prec
ision, coordination, flexibility, tenacity, imagination and expression are the e
ssence teaching ballet.
The classical technique has certain principles of posture and body placement tha
t must be maintained in all movements (Malange, 1985). According to Malanga (198
5), Bambirra (1993), Di Donato (1994) and Achcar (1998), was the end of the seve
nteenth century that Pierre Beauchamps defined the basic positions of classical
ballet, describing the beginning or the end of compulsory all steps. To obtain a
good placement posture, Sampaio (1996) suggests some basic principles: (a) feet
must bear the weight of the dancer's body and the arch of the foot should be en
couraged upward to avoid overloading the joint of hallux (b) the hip is the basi
s for a perfect placement posture, so it is essential to strengthen the abdomina
l and gluteal muscles, and promote the elongation of the quadriceps, (c) bringin
g the shoulder blades down, lift your chest, take out the ribs and oblique muscl
es of abdomen to maintain posture, (d) the arms are always rounded, and the elbo
w is the most important point, it suspends the arm and it is he who lead the mov
ement. The "en dehors" principle is more important in the ballet, which, accordi
ng Achcar (1998), is learning to turn the legs out with their toes out, heels in
, knees and thighs following the toes. To Sampaio (1996), the degree of external
rotation on femoral joint is determined primarily by the bone structure and cha
racteristics of articular ligaments. Its normal level, for individuals in genera
l is 40-50 degrees in each joint, making a angle of 80 to 100 degrees. In the fi
rst position, a dancer it reaches 180 degrees.
PRACTICE OF CLASSICAL BALLET
A class always begins with ballet barre exercises. According to Cosentino (1985)
, the bar serves to support the execution of exercises that will give dancers se
curity, support, lightness, proper muscle and knowledge of the other steps and m
ovements
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Injuries in classical ballet
91
technicians. After the exercises the bar, get the center exercises, in which the
y perform movements based on activities already carried out at the bar, but with
out the aid of this, seeking a better balance of the dancer. At the end of class
, come the port de bras, which are combined with arm movements and head movement
back, not forgetting of the breath, which must be worked in harmony and awarene
ss. And like a farewell, it is a series of movements called reverence. Most part
icipants ballet, according Schafle (1996), consists of beginners. In general, th
ey attend classes once or twice per week and the average level of intensity vari
es by school. The student receives lessons at beginner shoes soft leather or can
vas. Classes for beginners concentrate on basic positions of the legs and arms c
ontrol in the trunk and external rotation properly. It emphasized the developmen
t of strength, coordination and grace. According to Hill (1989), the practice of
ballet is recommended after six years, the fact that, at this age the child alr
eady has motor coordination and muscular system developed further as to maintain
balance and posture , ie assimilate the technique and have better technical res
ults faster. For Bambirra (1993), the age to start ballet should be around 4-6 y
ears of age, but the work to be developed should be fun. Agreeing, Lima (1995) m
entions that one should avoid the application of pure classical ballet technique
in childhood, but exalt the taste stimulus and the musicality and natural movem
ent. In the intermediate levels, according Schafle (1996), ballet classes, there
are fewer participants. The classes are attended 3-5 times per week and intensi
ty levels are increased. The girls begin to work on tiptoe and both sexes begin
to increase the height and complexity of the jumps and spins, and to pursue more
advanced attitudes or positions of equilibrium. As the skill level increases,€t
he frequency of classes also increases and may now include summer sessions with
teachers and strangers dancing days longer than usual.
Therefore, attempts to increase the external rotation (en dehors) and flexibilit
y can increase disproportionately to the skill level of the student. According t
o Lima (1995), the ballet teacher must verify individual maturation to capture t
he movements considered faster or slower absorption. Each individual has their o
wn reaction rate, which will be adapted according to the choreography required.
Not require advance quickly from those who have slower reaction time absorbing a
nd understanding of movement. At advanced levels, according to Schafle (1996), t
he introduction of work on tiptoe is the first step towards separating the serio
us from those dancers who wish or who may be able to dance only with recreationa
l purpose. From the first class, the bar and center in the ballet exercises desi
gned to strengthen the foot and lower extremity in preparation for work on tipto
e. The strength and level of technique should be the criteria for deciding when
it is possible to dance on tiptoe. Teaching the technique of using the pointe sh
oe is very important and the teacher ought to know when children should start us
ing the pad, not just the right age, but also observe the child's maturation (Ha
nkin, 1997). Lima (1995) reports the importance of using strategies to introduce
the tip shoes at the right time. He considers it important to start after puber
ty, and even then, checking the actual physical conditions and preparatory indiv
idual to receive such an effort and burden of joint exercises in the region requ
ested more toes, metatarsal and toes. You must also pay attention to the type of
material that the student has, for a sneaker that lets your foot is broken or i
rregular too much could lead to a fracture or injury, because, according to Sean
and Gallagher (1996), is of fundamental importance that the teacher guide the s
tudents regarding the material it uses, since the protection of fingers with adh
esive tape to buying the shoes that fit your body type.
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Guimaraes and Simas
Schafle (1990) states that some children are ready to work on tiptoe to 9 years
old and others never will. Already Bambirra (1993), save the child, to 11 or 12
years is ready to receive the effort to work on tiptoe. The work begins when the
tip of the bottom end is strong enough to maintain balance and correct alignmen
t without the help provided by the contact of the entire foot. The stand on the
tips is not only a technical change, but also an adaptation of the body to a new
form of equilibrium with the fortification of bones, tendons, ligaments and mus
cles.
POSSIBLE INJURIES RELATED TO CLASSICAL BALLET
The ballet is characterized by the constant search for aesthetic patterns of mov
ements, ie movements of large amplitude coordinate that go beyond the anatomical
limits. According to Hamilton et al. (1992), Wiesler et al. (1996) and Khan et
al. (1997), muscular strength and high range of motion in the joints of the hips
(maintenance of external rotation of 90 degrees) and knee (hyperextension), far
beyond the control of the ankle joint are some of the characteristics that lead
to the dancers no anatomical movements. These patterns of movement does not ana
tomical characteristics associated with musculoskeletal and physiological charac
teristics varied, the distinguished classical ballet sporting activities, thereb
y, the ballerina peculiar to a group of associated injuries (Klemp, 1984; Kadel
et al., 1992 ). The use of tip shoes, according Achcar (1998), when started too
early, force the bone structure muscle, tendons and ligaments, leading to seriou
s orthopedic problems in children, such as flatfoot, in which the curvature does
not develop, leaving loose ligaments, creating hernias capsular ligaments of th
e joints and bone callus. To Sampaio (1996), certain trends and strain may worse
n initially imperceptible, like back problems,
observed in positions almost always wrong. There are several dancers with bunion
s, corns and knee problems. May arise elastic knee or back, as a result of sprai
ned ligaments. Other strains may still come from the early use of tips, with cla
w feet, or with the fingers curled, as its name suggests. According Schafle (199
6),€work on the tip causes the first two metatarsals bear most of the weight. Co
nsequently, when children learn to dance on tiptoe, the bones begin to suffer th
ese processes of remodeling, so the cortical of the first and second radius beco
mes much thicker than in children who do not dance. During training and even thr
ough his career, these bones, particularly the second radius, are at risk of suf
fering a stress fracture. The same author considers that the usual manifestation
is that of gradual onset of pain at the base of the second metatarsal, which at
first increases with the work on tiptoe, and is usually followed by pain in ado
pting the position of middle point. If untreated, pain can manifest itself even
in the floor. If dietary deficiencies are excluded and if the body fat seems to
be within the limits of good health, treatment consists of rest with respect to
aggravating activities, while the force is maintained with exercises that do not
produce pain. Of course, citing Schafle (1996), dance on tiptoes is associated
with a set of problems and injuries from overuse. As shoes for work are much mor
e rigid tip and narrower than the half tip shoes, to perform traction on the flo
or is even more difficult when the feet are fully in contact with the surface. T
he lack of strength in the foot and ankle can result in acute ankle sprains or o
veruse injuries such as peroneal tendinitis, Achilles tendinitis and posterior t
ibial tendinitis. According Kadel et al. (1992), the formation of a classical da
ncer starts early, as it is necessary to fully develop physical skills such as s
trength, range of motion, flexibility, endurance, coordination,
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Injuries in classical ballet
93
speed and balance for an adequate performance. Besides the factors mentioned abo
ve, the repetitiveness characteristic of classical dance leads to too much burde
n on the lower limbs, causing imbalances between muscle groups, altering the bio
mechanics of the musculoskeletal system ligament thereby undermine its function,
and increasing their susceptibility to injury. In dance, most injuries are due
to errors and technical training. Schafle (1996) states that the most frequent e
rror is the forced turnover. Forcing the foot rotated out into the soil at the e
xpense of the knees, hips and back, causing a predictable pattern of injuries, i
ncluding tendonitis hip flexor, irritation of facet joints, stress fractures of
the portions interarticularis, chronic inflammation of the collateral ligament m
edial and medial tibial stress syndrome. The same author adds that the strength
of external rotators to maintain the rotation en dehors - during the motion is t
herefore of paramount importance. Insufficient development of the external rotat
ors produce a medial inclination of the knee during the plie and heels. This can
cause problems patelllofemoral, patellar subluxation and tendonitis by overuse
of the hip adductors and the patellar tendon. According Schafle (1996), the prob
lems that often occur in children are due to attempts to force the movement en d
ehors, which is the ballet term for external rotation of the hips. However, the
dancers usually measure their external rotation by observing the position of the
feet. Children understand very early, during the ballet classes, the external r
otation at the hip is extremely important, and often they will try to increase t
hat speed, carrying out some fairly draconian forms of stretching. A practice of
young dancers is to sleep in the butterfly position, ie face down with hips fle
xed and externally rotated as much as possible, and if this is not enough, the c
hild may ask a partner to stand on buttocks to increase the stretch in the hips.
Alternatively, the young dancer can stay in the supine
throttle position as a partner is standing, leaning on the medial aspect of her
knees. The training performed by dancers, according Coltro and Campello (1987),
very little or almost nothing specifically refers to the abdominal muscles, so w
hile it works fully the extent of the lumbar spine (paravertebral muscle strengt
hening and stretching the abdominals ), strengthening the abdominal muscles is t
he charge of "hip socket, pelvic retroversion, ie isometric contraction of muscl
es. What is insufficient for maintaining the balance between these two major mus
cle groups,€maintainers of the posture of the lumbar spine. Thus, the lumbar spi
ne is exposed to injury by not building and care of this area. Another frequent
error, according Schafle (1996), both young and advanced dancers, is the repetit
ion of a certain part of the choreography. Unfortunately, the repetitions contin
ue even after the fatigue of the tip due to the determination of the dancers in
attaining perfection. Most injuries occurred with the increase in class time, si
nce according to the same author, tests or a sudden change of technique, either
in advance of class or level of choreography, for which no classical ballet bar
prepares the dancer. The inequality of the partners is also a source of injuries
, particularly the introduction of pairing classes at the intermediate level. Of
ten, the dancers were not prepared to raise with special exercises or not well l
earned the technique of lifting weights before the first attempt to lift the bal
lerina. Moreover, the dancers to be raised may be inexperienced and unprepared t
o participate actively in surveys. According to Gantz (1989), the work incorrect
ly demi-plie, relevé passé and can lead to back problems, knees, feet and ankles
. In demi-plie, is due to hyperextension or flexion resulting from excessive ant
erior or posterior pelvic movement. The joints are affected by the force placed
on the feet, ankles and knees. In the past, and the column
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Guimaraes and Simas
pelvis are supported by one leg, in which the entire body weight is placed, and
yet it is swings and turns, leaving the spine in hyperextension. The repetition
and excess can lead to fractures and knee injuries, spine, ankle and foot. In re
levé, instability and misalignment of the spine in line with the pelvis, the wei
ght of the body is all about the toes can lead to spinal injuries, ankle, feet a
nd knees. The orthopedic problem in the feet can cause, citing Solomon (1991), m
ore serious problems in the ballet. The position of gripper in order to settle t
o the floor with his feet inside causes rotation or pronation, causing internal
rotation and eversion of the first ray, biomechanical setting the stage for the
formation of the bunion. The concern with their feet, pronation and external rot
ation insufficient level of the hips combine to impose an external sprain on the
tibia. This can cause pain in the medial compartment of the knee, stretch the m
edial collateral ligament and result in problems of patellofemoral dysfunction,
patellar tendinitis and chondromalacia patella. According Schafle (1996), is obs
erved in the dancers, stress fractures of the second metatarsal, tibia, fibula a
nd portions interarticularis. The pain of these areas, nãoexplicadas other diagn
oses should be attributed to stress fractures until proven otherwise by the squa
dron bone. The treatment of stress fractures depends on the level of skill or pr
ofessional goals of the dancer. For example, the novice dancer who has hopes of
being recruited by a professional company will not accept a treatment of rest, i
t is likely that should receive support in the rest of learning, resting, when p
ossible, during the summer. Participates in performance that is more important t
o her, next month and then do the rest for his stress fracture. A study by Palaz
zi et al. (1992) showed that injuries are the most common foot and ankle, follow
ed by knee and hip, and those that happen are the least of the upper limb. The a
uthors argue that these injuries occur due to excess
exercises and repetitions, always the same side, and also the early and incorrec
t use of pointe shoe. Miller et al. (1992) also indicate that injuries are the m
ost common foot and ankle for the same reasons cited above, and also add that ma
ny of these injuries occur in the wrong direction on the part of instructors. Th
ordason (1996) cautioned that the majority of injuries occur from stress, and al
most always happens at the same location, especially foot and ankle. The author
notes that it is an injury that can lead to fractures typically result from inco
rrect and that training will increase as it continues to train. The incorrect te
chnique and early results in lesions that often end up with the career of the da
ncer. This can occur when working excessively one motion, mainly in the pointe s
hoe, in which all the body's weight is being supported by the feet and sometimes
by only one foot, and these excessive movements, done incorrectly, in a inadequ
ate floor, with a poor technique and always using the same leg,€can lead to inju
ries in the foot and ankle (and SEAN GALLAGHER, 1996).
CONCLUSION
Through theoretical analysis and consultation respecting the limitations of the
study, concluded that: - the ballet, like any physical activity that requires re
peated contractions of certain muscle groups, has its own set of associated inju
ries, in which more common are the foot and ankle, followed by knee and hip, and
finally, the upper limb - if parents and doctors are careful in order to mainta
in a good working relationship with the dance instructor, some problems associat
ed with the training of ballet can be eliminated. Parents should seek competent
professional and specialized schools for their children and monitor classes, avo
iding in this way, future problems. - Lesions of young dancers in general are se
lf-induced, with the pursuit of extreme
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Injuries in classical ballet
95
external rotation, as most likely culprit. The explanation of the effects in the
long term, technique incorrect, will help the young dancer to improve technique
and strength, and have faith that these efforts, over time, will produce the de
sired external rotation - the also important is to insert the technique of class
ical ballet at the appropriate time, avoiding to apply the pure technique of bal
let as a child, but exalt the taste stimulus and the musicality and natural move
ment. Use
strategy for the introduction of shoes tip at the right time after puberty, and
even then, checking the actual physical conditions and preparatory to receive su
ch individual effort and overhead exercises in the region sought to articulate m
ore toes, metatarsal and toes. Taking these precautions, the dancer's career wil
l probably happen with fewer injuries and disappointments.
Injuries IN CLASSICAL BALLET
ABSTRACT This study Aimed to elucidate what injuries are most Likely to Occur du
e to classical ballet practice. The research Used national and international bib
liography. The bibliography analysis Indicated That Demands esthetical and techn
ical lead to the practice of non-anatomical movements, causing the ballet dancer
to Suffer from a number of Associated lesions. Most of the injuries are Caused
by technical mistakes and wrong training. Troubles in children are usually; Tryi
ng to force due to external rotation at hip level and point to undue use of ball
et slippers. The commonest lesions are in feet and ankles, knees and hips Follow
ed by. The rarest ones are in the upper limbs. These injuries are Caused by exce
ss exercise, by repetitions always in the Same Side and wrong and by early use o
f point slippers. The study Reached the Conclusion That incorrect application of
classical ballet technique predisposes the characteristic injuries to dancers.
Key words: dance, classical ballet, injuries.
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Received 24/07/2001 Revised 14/08/2001 Accepted 08/29/2001
Correspondence to: Joseane Paulini Neves Simas, Av Tromposky No 227, apto 1201,
Centro,
Florianopolis, Santa Catarina, Brazil, Cep. 88015-300. E-mail: fabguima@terra.co
m.br or joseanisimas@yahoo.com
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