Dance injuries associated with pointe work are very common in the dance community especially among young dancers who are growing up and at the same time have to learn demanding physical strength and technical skills. Pre-pointe assessments are used to determine whether ballet dancers are safe to progress to dancing en pointe. These changes typically occur around the age of 12.
Basic assessment protocols have not yet been standardized but attempts have been made to identify musculoskeletal changes between pre-pointe and novice pointe students to determine readiness. Previously chronological age age dance training ankle plantar flexion range and correct execution and only relevé indicates readiness. But research shows that a combination of biomechanical assessment and assessment of overall kinetic chain muscle imbalance compensation and other postural data is very useful for assessing safe and successful performance. Similarly, there is no research on pre-course training programs. While a system is often introduced and is extremely useful, there is no standard gold standard.
There is much debate as to who should complete the pre-pointe assessment for the dancers but it is thought that a health practitioner has the most influence on the pre-pointe assessment. Functional tests that assess core stability strength and flexibility of are also indicated the alignment and posture of the lower legs and ankles may be a good indicator of when a dancer is ready to begin pointe work.
Please refer to the glossary at the bottom of this page for definitions of any unfamiliar ballet terms.
General Criteria Used
- Dancers are generally encouraged to begin pointe work between the ages of 11 and 12. There are significant differences in musculoskeletal and physical development at this age. There is a normal growth rate that can increase the risk of growth plate injury
- Years of dance
- It is assumed that by the age of 12, a dancer has participated in at least 3 or 4 years of classical ballet training and therefore will have mental capacity strength mechanical skills coherent coordination skeletal development and physical fitness management a it is necessary to start a pointe career
- Dance students will pay for bruises or other injuries that have not fully healed
- Relevé alignment and stability
- Plié alignment and stability
- Upper body alignment and stability
- Technical qualifications and skills acquisition
- When evaluating a dancer, style is often considered. According to Meck, the most valuable feedback on technical requirements was to focus on evaluating a relevé plié and tendu.
- The requirement for sufficient ankle plantar flexion range of motion is important for pointe work
Intrinsic Muscle Strength
When a dancer moves to full pointe, the foot muscles work 2.5 to 3 times harder than other muscles in the foot. Because ballet is so repetitive chronic fatigue of the muscles across the joints of the foot is a major cause of pointe associated injuries work.
Strength Control of the Lower Limbs and Muscles
When considering the strength of the lower ground it is important to look at the entire chain of movement. This is because the range of motion of the lower limbs is highly dependent on the stability of the spine and trunk. To achieve stability in the spine and trunk, a dancer must engage their core muscles. This helps give them the power needed to carry out the necessary movements.
In the single-leg stance, a dancer relies heavily on their hip flexion and back muscle rotation to keep her spine in alignment. This becomes more difficult when the base of support is reduced further (i.e. when it climbs to pointe). Compensation further along the kinetic chain can be found at horizontal posture. This can also increase a dancer’s risk of inversion sprains.
While there is no gold standard, some evidence-based tests can provide an idea of pointe collection and are recommended in pre-pointe assessment.
The single leg leg rise test can provide an objective measure of leg flexion strength and can be used to help determine a dancer’s readiness for pointe training. A 25 foot elevation is considered normal for human gait.  .
DeWolf et al. also advise that 15 continuous single-leg relevés and 2 cycles of the flight test should be considered as cut-off levels when performing pre-pointe checks.
Assessment of dynamic motor control such as controlling alignment during specific ballet tasks may also be useful in the pre-pointe assessment. The flight testing topple test and the sauté test were able to distinguish dancers of different levels (i.e. pre-pointe beginner pointe and middle pointe) and can be useful for determining pointe readiness.
Both relevé endurance tests and flight tests can be used to differentiate pre-dancers from pointe dancers. These tests also discriminated between dancers of varying skill levels who combined both style and physical ability.
1. “Flight” Test .
Objective: To measure power control of the lower extremities primarily and balance. Hewitt et al. have found this test to be a useful way to determine a dancer’s ability to hold their spine in a neutral position.
Directions: The dancer stands flat-footed on one leg. They bend at the hips and extend the nonsupporting leg backward until the foot is parallel to the trunk and floor. In this pose, the dancer faces downwards. This is where they raise their arms next to their bodies the shape of a “T.” Once the back of the body and the legs are level with the floor, the dancer bends their supporting leg. At the same time as the tree is leveled with the non-supporting leg, the hands are lowered (fingers extended) until the fingertips contact with the floor in front of them. The dancers then straighten their knees and arms to return to the starting position. The test is terminated if the dancer moves the supporting leg and falls out of position or chooses to quit. The sum of the completed repetitions on both sides is given overall score.
Remember: Try both right and left.
Note: Effort is considered unsuccessful when pelvic drop hip adduction hip internal rotation knee valgus or foot dropping during locomotion.
2. Sauté Test 
Purpose: To evaluate the dynamic control of the trunk and the alignment of the lower limbs.
Directions: The dancer starts in a coupé derriere. They turn their gesture and standing legs and place their hands on their hips or across their chests. The dancer jumps into the air and must achieve the following:
- Neutral pelvis
- Upright / stable trunk
- Straight standing leg in the air
- Pointed standing foot in the air
- The legs supporting the coupe cannot move
- They must be controlled to fall into the plié (i.e. they roll from toe to ball of foot to heel)
Study participants by Hewitt et al.  attempted up to 16 sautees per leg. They add the left and right scores to get a total score. Pass at least 8/16 correctly executed jumps. 
Remember: The single-leg scramble test should not be followed by the single-leg heel raise test, since both tests primarily assess calf muscle strength. 
NOTE: Slow motion analysis is necessary to assess all criteria required to pass the test. 
3. “Topple” Test
Purpose: To assess a dancer’s ability to perform a clean spin. 
Explanation: A clean convolution is defined as: 
- Proper starting position (i.e. square hips with most weight on front foot, pelvis centered and dancer has strong arms)
- dancers lift their legs up in one count
- The supporting leg is straightened
- Dancers unite their torsos as one
- The dancer’s arms are powerful and must be placed correctly
- The dancer demonstrates a quick spot
- The landing must be controlled
In the Hewitt et al.  study one point was awarded for each criterion met. The best pirouette with each leg gets one point and an overall score is given based on the scores from the left and right legs. 
Remember: the dancers in the study by Hewitt et al.  made 3 attempts per leg to complete the roundabout.
NOTE: The test should be recorded so that the video can be replayed in slow motion for more precise analysis. 
4. Pencil test – plantar flexion ROM
Purpose: To determine global plantarflexion of the ankle-foot complex. 
Instructions: The dancer assumes a sedentary position. Place a ruler or pencil on top of its dorsal talar neck. Dancers pass this test if they achieve sufficient plantar flexion (i.e. 90 degrees or more). This is achieved when the straight edge clears the far end The tibia is just close to the ankle joint. 
Remember: a super-maneuverable person will do well on this test. 
NOTE: It is important to correct excessive flexion of the foot. 
5. Single leg heel lift test
Purpose: To determine the endurance of the calf musculature. 
Instructions: The dancer stands on one leg. They put the other leg in the parallel coupe. The dancers were asked to perform as many relevés as possible without plié, at 120 relevés per minute (i.e. 30 heel lifts per minute). If the dancer can no longer take the test, the test ends Keep up with the beat or they choose to stop. The test also stops if the dancer completes 75 relevant moves. Test each side and add together the relevant totals. 
This test can also be performed as follows: Posterior calf strength is measured by counting the number of parallel single-leg heel raises a dancer can perform while maintaining the relevant height before the straight-leg test. A “pass” for this test is defined as Perform 20 or more calf raises. 
Remember: Batalden  states that at least 90 degrees of plantarflexion of the subtalar joint is required to lock the toe and thus help avoid injury to the ankle ligaments. In their tests, Batalden  included a standard 15° of dorsiflexion.
Note: For 5- to 8-year-olds, the mean number of repetitions of the hip lift test has been found to be 15.2. The average number of repetitions among 9- to 12-year-olds is 27.7.
6. Double Leg Lower Test
Purpose: To objectively evaluate abdominal strength.
Direction: The dancer lies on the floor. Their spine is in a neutral position and both legs are flexed to 90 degrees at the hip to perpendicular to the testing surface. With both knees extended, the dancer is asked to slowly lower their legs to the testing position. He is the researcher observe the stability of the hip and record the position of the leg as the spine begins to rotate forward. Energy scores are assigned based on these angles.
Remember: This test is recorded as passed if this angle is 45 degrees or less.
Note: Check for any increased biomechanical compensations.
7. Modified “Romberg”.
Objective: To determine proprioception and fall risk.
Directions: The dancer stands in one parallel leg. They cross their arms and close their eyes. A dancer passes this test if they can hold this position for more than 30 seconds: opening their eyes touching the non-supporting leg downwards or without dropping their standing leg.
Please click on the link for more information about the Romberg Test.
8. Timed Plank Test
Objective: To assess core endurance and the ability to maintain a neutral pelvic position.
Directions: The dancer starts in perfect planks on their hands and toes. Adequate pelvic alignment must be achieved before the test can begin. The examiner plays how long the dancer can hold this position. The test ends when the dancer can no longer hold the spine in a normal position or falling to their knees. They also stop after five minutes.
NOTE: Being able to keep the core stationary while maintaining a neutral pelvis is important for control and balance during barre and center work. 
9. Star Game Balance Test (SEBT)
Aim: To measure dynamic balance.
Instructions: There are two commonly used versions of this test, both with links to pages that further describe the test. This course involves a test called the Y balance test, in which the individual balances on one leg and touches 3 different points on the floor with the non-weight-bearing foot. this The second test is called the Star Drift Balance Test (SEBT) and is shown in the figure. For this test, four strips of athletic tape (each 6-8 feet long) were cut. Two pieces are used to create a “+”, while the other two strips are used to create an “x”, which is positioned on top of the “+”, thus forming a star. Each strip must be separated by a 45 degree angle.  During SEBT, the goal is to maintain a single-leg position while reaching the opposite leg as far as possible along the star point. 
Remember: Follow all required directions to complete the test.
Guidelines from the International Association of Dance Medicine and Science (IADMS) 
The IADMS provides the following guidelines for when to start pointe training:
- “Not before age 12.
- Pointe training is not permitted if the student is not anatomically sound (eg, insufficient ankle and plantar range of motion; poor lower body alignment).
- If she’s not a true preschool professional, discourage pointe work.
- If she has weak trunk and pelvic (“core”) muscles or weak legs, delay pointe work (and consider implementing a strengthening program).
- Delay pointe training (and consider implementing a strengthening program) if the student’s feet and ankles are hyperactive.
- If your ballet class is only once a week, don’t do pointe work.
- If ballet classes are held twice a week and none of the above apply, start in Year 4.
- ↑ Jump up to:1.0 1.1 Altmann C, Roberts J, Scharfbillig R, Jones S. Readiness for en pointe work in young ballet dancers are there proven screening tools and training protocols for a population at increased risk of injury?. Journal of Dance Medicine & Science. 2019 Mar 15;23(1):40-5.
- ↑ Jump up to:2.0 2.1 2.2 2.3 Richardson M, Liederbach M, Sandow E. Functional criteria for assessing pointe-readiness. Journal of Dance Medicine & Science. 2010 Sep 1;14(3):82-8.
- ↑ Jump up to:3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 DeWolf A, McPherson A, Besong K, Hiller C, Docherty C. Quantitative measures utilized in determining pointe readiness in young ballet dancers. Journal of Dance Medicine & Science. 2018 Dec 1;22(4):209-17.
- ↑ Jump up to:4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 Green-Smerdon M. Pre-Pointe Assessment Course. Plus. 2022.
- ↑ Russell JA. Preventing dance injuries: current perspectives. Open access journal of sports medicine. 2013;4:199.
- ↑ Glumm SA. Functional Performance Criteria to Assess Pointe Readiness in Youth Ballet Dancers.
- ↑ McCormack MC, Bird H, de Medici A, Haddad F, Simmonds J. The physical attributes most required in professional ballet: a Delphi study. Sports medicine international open. 2019 Jan;3(01):E1-5.
- ↑ Meck C, Hess RA, Helldobler R, Roh J. Pre-pointe evaluation components used by dance schools. Journal of Dance Medicine & Science. 2004 Jun 1;8(2):37-42.
- ↑ Barreau X, Gil C, Thoreux P. Ballet. Injury and Health Risk Management in Sports 2020 (pp. 725-731). Springer, Berlin, Heidelberg.
- ↑ Willson JD, Dougherty CP, Ireland ML, Davis IM. Core stability and its relationship to lower extremity function and injury. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2005 Sep 1;13(5):316-25.
- ↑ Hébert-Losier K, Wessman C, Alricsson M, Svantesson U. Updated reliability and normative values for the standing heel-rise test in healthy adults. Physiotherapy. 2017 Dec 1;103(4):446-52.
- ↑ Thomas KS. Functional eleve performance as it applies to heel-rises in performance-level collegiate dancers. Journal of Dance Medicine & Science. 2003 Dec 15;7(4):115-20.
- ↑ Jump up to:13.00 13.01 13.02 13.03 13.04 13.05 13.06 13.07 13.08 13.09 13.10 13.11 13.12 13.13 13.14 13.15 13.16 Richardson M, Liederbach M, Sandow E. Functional criteria for assessing pointe-readiness. Journal of Dance Medicine & Science. 2010 Sep 1;14(3):82-8.
- ↑ Jump up to:14.00 14.01 14.02 14.03 14.04 14.05 14.06 14.07 14.08 14.09 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 Hewitt S, Mangum M, Tyo B, Nicks C. Fitness testing to determine pointe readiness in ballet dancers. Journal of Dance Medicine & Science. 2016 Dec 15;20(4):162-7.
- ↑ Jump up to:15.0 15.1 15.2 15.3 15.4 15.5 15.6 Batalden L. Pointe-Readiness Screening and Exercise for the Young Studio Dancer. Orthopaedic Physical Therapy Practice. 2020;32(1):48-50.
- ↑ Agrawal Y, Carey JP, Hoffman HJ, Sklare DA, Schubert MC. The modified Romberg Balance Test: normative data in US adults. Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2011 Oct;32(8):1309.
- ↑ Jump up to:17.0 17.1 Ani KU, Ibikunle PO, Nwosu CC, Ani NC. Are the Current Balance Screening Tests in Dance Medicine Specific Enough for Tracking the Effectiveness of Balance-Related Injury Rehabilitation in Dancers? A Scoping Review. Journal of Dance Medicine & Science. 2021 Dec 15;25(4):217-30.
- ↑ Jump up to:18.0 18.1 Olmsted LC, Carcia CR, Hertel J, Shultz SJ. Efficacy of the star excursion balance tests in detecting reach deficits in subjects with chronic ankle instability. Journal of athletic training. 2002 Oct;37(4):501.
- ↑ Plisky PJ, Gorman PP, Butler RJ, Kiesel KB, Underwood FB, Elkins B. The reliability of an instrumented device for measuring components of the star excursion balance test. North American journal of sports physical therapy: NAJSPT. 2009 May;4(2):92.
- ↑ Jump up to:20.0 20.1 Weiss DS, Rist RA, Grossman G. Guidelines for Initiating Pointe Training. Journal of Dance Medicine ci Science• Volunae. 2009;13(3):91.