Ballet is one of the most physically demanding art forms in the world. It looks effortless on stage with graceful lines, soft landings, and fluid movements. But if you’ve ever done ballet, you’ll know that beneath that elegance lies extraordinary strength, precision, and repetitive load - and bodies that must sustain that without injury.
As such, PhysioCentral is proud to be the principal physiotherapists for the Hong Kong Ballet, having worked on productions like The Nutcracker, where our physiotherapists are involved in caring for the health and well-being of all of the dancers. But our work with ballet extends far beyond seasoned professionals. We support dancers across all levels - including beginners, because the physical demands of ballet are incredibly real at every stage.
Today, we’re talking about the role of physiotherapy for ballet dancers, why ballet places such unique stress on the body, and what dancers (including parents of younger dancers) should look out for to help keep their bodies safe.
Why Ballet Is So Physically Demanding?
Ballet requires a unique combination of strength, control, power, mobility, and artistry - often all at once. Many movements push the body into positions that rely on exceptional technique to stay safe. Some key demands of ballet include:
1. Turnout
Correctly achieving turnout requires good hip joint mobility, deep hip rotator strength, core control, and alignment through the knees and feet. When turnout is forced - relying on the feet or knees rather than the hips - it strains the joints, increases a person's injury risk, and eventually affects performance quality.
2. Pointe work
Dancing en pointe places high demand on the ankles, intrinsic foot muscles, calf complex, big toe joint, and overall lower-limb stability. Even slight fatigue in these structures can quickly turn into pain or injury, especially during long performance and rehearsal seasons.
3. Repetitive jumping (allegro)
Grand allegro, jetés, assemblés, and other jumps require repeated, powerful take-offs and controlled landings. This places load through the Achilles tendon, the calf muscles, the tibia, the knees, the hips, and the lumbar spine. Fatigue or technique drift can increase the risk of overload injuries.
4. Extreme ranges of motion
High extensions, arabesques, développés, and port de bras demand not only flexibility but also strong, stable control at end range. That control is what keeps dancers safe.
5. Prolonged rehearsals
Hours of repeated movements - often practising the same sequence again and again - can accumulate into tendon irritation, hip pinching, back stiffness, foot fatigue, and overall physical exhaustion. This is magnified in seasons where dancers may also be attending extensive workshops.
Common Injuries We See in Ballet Dancers
Even with excellent technique, ballet places great demands on the body. As such, some of the most common issues we treat include:
1. Ankle Sprains and Instability
Ankle sprains are extremely common in ballet due to the repetitive strain on the foot and ankle during class, rehearsals, and performances. They often develop from poor foot alignment, fatigue during jumping, the heavy load associated with pointe work, or small technique errors during landing. If not managed properly, these sprains can lead to chronic ankle instability, recurring swelling, and even decreased confidence for en pointe or during allegro work. This is where early physio assessments focused on identifying any weaknesses and focusing on strengthening can really help.
2. Hip Impingements
Hip impingements often present as a pinching sensation at the front of the hip during movements like développé à la seconde, retiré passé, grand battement, or any turnout-heavy position. When hip control or mobility is limited, dancers start to compensate through their lower back or knees, which can increase strain across multiple joints. Over time, this can reduce turnout quality, create lingering discomfort, and affect both flexibility and stability during high-leg work.
3. Lower Back Pain
Lower back pain is a common issue dancers face, particularly those who grip through their lumbar spine, lack deep abdominal control, or rely heavily on lumbar extension for arabesques and port de bras. Limited hip mobility can contribute further, forcing the lower back to take on more load than it should. With repetition, this pattern can irritate the facet joints or sacroiliac joint, leading to persistent pain that flares during extension-based choreography or after long rehearsal days.
4. Stress Fractures
Stress fractures can affect several areas in dancers, most commonly the tibia (shin bone) and the metatarsals (long bones) in the feet. They can also occur in the lumbar spine (pars fractures) or, less commonly but more seriously, in the neck of the femur (part of the hip joint). These injuries usually arise from high training volumes, inadequate recovery, poor nutrition, or low energy availability - often in dancers pushing through intense workloads or preparing for major performances. Addressing early signs such as persistent ache, swelling, or “bone-deep” soreness can go a long way toward preventing more serious damage.
5. Tendinopathies
Tendinopathies in ballet dancers frequently develop in the Achilles tendon, posterior tibialis, hip flexors, and hamstrings. These conditions are the result of repetitive load and often begin as mild stiffness that worsens with continued training. If ignored, they can progress into more painful, persistent injuries that limit jumping, relevés, développé height, and overall endurance. Early intervention focused on strength, load management, and technique correction is essential for long-term recovery.
Injuries Aren’t the Whole Picture
Some of the most valuable work we do with dancers happens before an injury occurs. Physiotherapy helps dancers understand how their bodies move, how to manage the physical demand of ballet, and how to build strength and technique that supports longevity in their dancing career - whether they dance recreationally or professionally.
How Physiotherapy Supports Ballet Dancers
Physiotherapy care helps dancers stay strong, balanced, and reduces their risk of injury, regardless of their experience level. Here’s how we support dancers in a way that blends technique, strength, and long-term physical resilience:
1. Technique-Focused Assessment
One of the first things we look at is how a dancer actually moves. This includes the way they jump and land, how they control turnout, the alignment of their hips and knees during pliés, the stability of their feet en pointe, and their posture in positions like arabesque, retiré, or développé. Small technical habits, such as gripping in the lower back, rolling in through the feet, or forcing turnout from the knees, can place unnecessary strain on the body. A physiotherapist trained in ballet biomechanics can spot these patterns quickly and help dancers make corrections that prevent injury and improve performance quality.
2. Strength Conditioning for Ballet
Although dancers are incredibly strong, many still have gaps in essential areas of technique. Physiotherapy helps build the type of strength that supports turnout, pointe work, extensions, balances, and powerful jumps. This includes strengthening the deep hip rotators, foot and ankle stabilisers, calves, core, and the muscles that support the spine and pelvis. Strength work helps dancers with their control, stability and confidence, while reducing fatigue and protecting them during high-demand times like this Nutcracker season we’re in!
3. Flexibility and Mobility Work
Flexibility alone isn’t enough for safe dancing - dancers also need control and stability at every end range. We help improve mobility in the areas that matter most for ballet, such as hip rotation for turnout, thoracic mobility for fluid port de bras, and ankle mobility for deep pliés and clean landings. Physiotherapy focuses on balanced mobility: gaining range where needed, but also supporting it with strength so dancers can access their flexibility safely and consistently.
4. Load Management During Rehearsal Seasons
When you’re rehearsing for a performance, hours of répétiteurs, spacing rehearsals, and full runs add up to a huge weekly load. Physiotherapists help dancers recognise early signs of overuse, manage fatigue, and adjust training intensity without compromising performance. This includes guidance on recovery strategies, tissue conditioning, pacing high-demand movements, and planning strength work around rehearsal schedules so dancers stay healthy from first rehearsal to final curtain.
5. Acute Injury Care and Backstage Support
During major productions, our physiotherapists help dancers warm up properly, release tight muscles, manage flare-ups, and stay ready for each act. We assist with everything from tight calves and irritated hip flexors to foot soreness, muscle spasms, or sudden tweaks from lifts or jumps. This support helps dancers feel calm, prepared, and physically capable.
6. Long-Term Injury Prevention
One of the most valuable aspects of physiotherapy is helping dancers understand their bodies - where their strengths are, where they compensate, and how to prevent injuries before they happen. We work on improving movement efficiency, building strong foundations, addressing technique habits that create strain, and teaching dancers how to listen to early warning signs. The goal is to support a long and healthy dance journey, from early training to advanced levels.
Ballet Injury Prevention Checklist
If you’re doing ballet at any level, here’s a quick list of things you can do to help lower your injury risk.
Daily Essentials
- Warm up for 10–15 minutes before class
- Use the small muscles deep in your hips (not your knees or feet) to create safe, controlled turnout
- Keep your ribs stacked over your pelvis to protect your back and improve balance and control
- Build the small muscles inside your feet to support your arches, improve pointe work, and reduce injury
- Include regular calf strengthening
Weekly Essentials
- Include 2–3 strength sessions (hips, core, feet, calves)
- Balance flexibility with control - stretch and strengthen
- Monitor training volume during busy rehearsal weeks
Warning Signs
Seek physio support if you notice:
- Pinching in the hip during turnout or développé
- Repeated ankle swelling or instability
- Aching shins, especially with jumping
- Back pain during arabesque
- Pain that worsens with repetition
If you’re involved in ballet, regardless of whether you’re just starting or are a seasoned professional, our team here at PhysioCentral are here to help. Our physiotherapists are highly experienced in working with amateur and professional ballet dancers and can support you too. Book an appointment online by clicking here or call us on +852 2801 4801