The Pointe Problem: Our Best Determinants for Success in Pre-Pointe Dancers
Any outside observer can be captivated by ballet, if only for one universal sentiment: wow, that looks like it HURTS.
It can, it does, and we aren’t even totally sure what the best way to introduce it is, (at least with good quality, standardized, research-backed confidence). Each studio has their own set of criteria, and often leans on the experience of more senior instructors to pass on the next wave of hopeful dancers from pre-pointe, to pointe. While we have research that actually confirms that a trained eye is in near agreement with some of our objective tests, we cannot very well correlate that skill to whether or not a graduated dancer will become injured.
By the nature of dance as a sport, we have trouble studying and objectively producing criteria for our artistic athletes. The movements are varied, and while dance requires the technical proficiency of a gymnast or a figure skater, there is also a heavier overlay of artistic expression and ample room for interpretation of modern technique. Guiding injury prevention seems to lay more in anecdotal experience, with tests that loosely measure single leg stability, motor control, and in a very isolated way, calf strength.
The research we do have is low-powered, with few numbers of participants per study and is lacking longitude. Throughout the last 20 years, we have used some firm anatomical and physiological checkpoints as well as more functional tests to determine what we think is a fair barrier to entry. In late 2024, the most recent publication of these tests to determine pointe readiness was studied among 27 dancers. These researchers (Shah et al.) compared rater test outcome to dance instructor agreement with the following determinants of pointe readiness:
Range of motion
Primary criterion for passing: Ankle plantarflexion >90°
Inter-rater agreement: 69% (25/36)
Relevé
Primary criterion for passing: Hold 5 seconds
Inter-rater agreement: 90% (61/68)
Relevé passé
Primary criterion for passing: Hold 5 seconds
Inter-rater agreement: 97% (33/34)
Grand plié
Primary criterion for passing: General stability
Inter-rater agreement: 73% (35/48)
Topple pirouette
Primary criterion for passing: Controlled landing
Inter-rater agreement: 62% (42/68)
Airplane test
Primary criterion for passing: At least 4 of 5 satisfactory
Inter-rater agreement: 85% (29/34)
Sauté
Primary criterion for passing: At least 8 correct
Inter-rater agreement: 76% (26/34)
Overall readiness
Primary criterion for passing: N/A
Inter-rater agreement: 94% (16/17)
The test is thorough in its description and markings as presented by the PASSE document itself, and may be the most detailed examination we have at this time to standardize the process of passing or failing a dancer for progression to pointe technique. What we cannot do is say with certainty that this set of criteria leads to fewer injuries in the years to follow. However, Shah’s team mentions that there is a tracking process and follow-up study on the way. Again…we have few participants so the weight is little, but appreciated.
Thoughts and Follow-Up:
In a former study, the Single Leg Saute Test was highlighted to be the best addition to the pointe exam. In its nature, it is the only plyometric test and demands the most eccentric strength of the muscles surrounding the ankle and foot. It begs the question, is there enough physical rigor to the tests we are having our dancers perform, and does it translate well to the endurance that they are expected to maintain in the classroom and on stage? We can’t yet tell.
Secondly, we have previous suggestions to avoid transitioning to point before the age of 12 to allow the foot to grow without repetitious loading while epiphyses continue to develop. However, this study, having allowed dancers as young as 9 to participate, rejects that dancers must wait until a certain age to begin pointe. Instead, Shah claims that the skilled recruitment of muscles for control is more important than maturation. This is novel, and in its justification is the documentation of only a single premature growth plate closure from dance. I have not seen any literature that follows dancers who begin pointe in early adolescence and tracks what the effects are in their later development.
Shah S, Valenzuela-Moss J, Sheng D, Wren TAL, Zaslow T, Edison B. Pointe Assessment Screen Shah Edison (PASSE) for Pointe Readiness: A Pilot Study. Journal of Dance Medicine & Science. 2024;0(0). doi:10.1177/1089313X241307736
Weiss DS, Anne Rist R, Grossman G. When Can I Start Pointe Work?: Guidelines for Initiating Pointe Training. Journal of Dance Medicine & Science. 2009;13(3):90-92. doi:10.1177/1089313X0901300304
Richardson M, Liederbach M, Sandow E. Functional Criteria for Assessing Pointe-Readiness. Journal of Dance Medicine & Science. 2010;14(3):82-88. doi:10.1177/1089313X1001400302
